subject_line
About you
Title
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Mr
Mrs
Miss
Ms
Dr
First Name
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Surname
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Date of Birth
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Email
*
Phone Number
House No.
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Street Address
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Town
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Post Code
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About your diagnosis
How old, and when were you diagnosed?
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What symptoms did you have?
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What treatment did you have / are you having? If you are still receiving treatment when is it due to finish?
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What (if any) side-effects did you experience?
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Where were you treated?
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Can you tell us a little bit about your experience?
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How has Weston Park Cancer Charity or the Cancer Information Support Centre helped you?
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About you continued...
What were you doing before you got diagnosed?
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Have you been involved with Weston Park Cancer Charity before?
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What are you doing now?
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Please upload a suitable picture which you are happy for us to use alongside your story. This should be a high quality image, maximum file size 20mb.
Your preferences
We’d like to keep you up to date with our work, fundraising activities and events. To receive these, please tell us the ways you are happy for us to get in touch with you:
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