Talk to a Guide Sign Up Form

Let's start with your name (nicknames are good too)

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Which of these best describes you?

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Haven't been diagnosed with testicular cancer but concerned for myself

Diagnosed with testicular cancer but haven't had treatment yet

Have had treatment for testicular cancer

I'm a partner, parent or caregiver to someone with testicular cancer

How old are you?

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If you're the parent or guardian of someone under 18, select their age instead of yours

Under 18

18 to 24

25 to 29

30 to 39

40 to 49

50+

If you're a family member or friend, what is the age of the person diagnosed with testicular cancer? (optional)

Under 18

18 to 24

25 to 29

30 to 39

40 to 49

50+

What are some topics you want to talk to your guide about?

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For example, struggling with diagnosis, difficulties talking to friends or family, planning for a baby, loss of confidence, how can I best support my loved one with testicular cancer, or self-care for caregivers

What's the best email we can reach you at?

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If you're the parent or guardian of someone under 18, please use your email here.

Agreement

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By checking this box and submitting the form, I confirm:I have read, understood and agree with the Privacy StatementI have read, understood and agree with the Nuts and Bolts Website Terms and ConditionsI consent to my personal and health information being collected by Movember and published on its website for the purposes of the Talk to a Guide program

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