Thank you for sharing your bladder cancer story.

The BCAN 2017 My Bladder Cancer Story Campaign will feature personal stories from those affected by bladder cancer, including current patients, survivors, caregivers and loved ones of those who have passed away from bladder cancer. By submitting your information to the My Bladder Cancer Story Campaign you give permission to have your story featured across multiple BCAN platforms including social media, newsletters, marketing materials, BCAN.org and more.

* 1. What is your gender?

* 2. What is your relationship to bladder cancer?

* 3. Slide to show how old you/your loved one were at the time of the bladder cancer diagnosis?

20
i We adjusted the number you entered based on the slider’s scale.

* 4. What year did you begin your bladder cancer journey?

1960
i We adjusted the number you entered based on the slider’s scale.

* 5. Which of the following tests or procedures were done for diagnosis? (check all that apply)

* 6. What information would you like to share about your diagnosis? (Share a little about what was like before your diagnosis. Did you have signs/symptoms? Was it easy to get your diagnosis? What tests did you have?)

* 7. What treatments have you or your loved one experienced? (Please check all that apply.)

* 8. Tell us about your experience with your bladder cancer treatment. (What was it like for you? For your family? What challenges did you face? How did you overcome them?)

* 9. How has your life changed because of your experience with bladder cancer?

* 10. What role has BCAN played in your bladder cancer story?

* 11. Do you have any suggestions or advice for newly diagnosed bladder cancer patients?

* 12. To which of the following groups do you belong? (Please check all that apply - we may use your story during specific group focused months of the year.)

* 13. Please provide the following so we may contact you for additional details and a photo when we use your story:

Thank you for sharing. We will contact you for photos and with any questions we have. If you have further suggestions, please contact Alejandra (aspangler@bcan.org) or Stephanie (schisolm@bcan.org).

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