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“I can’t express in words how amazing it is to talk to someone who has gone through what I am going through. The service you provide in connecting people in this situation is priceless.“

Julie B., Maryland

Please Read First:
Hope for Two…The Pregnant with Cancer Network is an international non-profit organization for women diagnosed with cancer during pregnancy. Our mission is to connect women who are pregnant with cancer with other women who have been pregnant with the same type of cancer. These women are here to lend support, offer hope and share their experiences with one another through phone and e-mail conversation.

If you are pregnant with cancer and would like to be connected with a volunteer support woman, please fill out the information below or call 1.800.743.4471. By doing so, we will research and connect you with a support woman from our network who shares a similar cancer and pregnancy experience.

If you have previously experienced cancer during pregnancy and are interested in becoming a volunteer support woman, please click here.

We are affiliated with the current national expert on pregnancy and cancer. She is Dr. Elyce Cardonick, an OB/GYN, Maternal-Fetal medicine specialist who is collecting data in her cancer and childbirth registry (database) of all pregnant women diagnosed with cancer and their babies. Pregnant women find her registry helpful in learning how many other pregnant women were diagnosed and treated for their same cancer during pregnancy. Please check the box in the form below if you do not want to be part of her Cancer and Pregnancy Registry.

For those who would like to consult with Dr. Cardonick by phone, she is happy to call if requested or you may phone her directly (her phone numbers are on our website). For those who are just interested in enrolling for the Cancer and Pregnancy Registry: once your signatures are received on the enrollment paperwork mailed to you by Dr. Cardonick, she will then phone you to answer any questions and complete the enrollment.

NOTE: Fields marked with * are required. If unsure of answer, please indicate so.

I was scared every time I sat in that chemo chair hoping you’d be okay. Everly Grace: You are more than perfection. You are strong. You are brave. Mommy loves you, little girl.

Bri

Hodgkin’s Lymphoma Survivor

Patient's First Name:

Patient's Last Name:

Date of Birth:

Address:

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If outside US, please type entire address as it should appear on envelope:

Are you the patient?:

If not, What is Your Name and Relationship to the Patient:

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Type of Cancer:

If Other, What Type?

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If breast cancer, what type:

Estrogen Receptor:

Date Diagnosed:

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Do you have other children and if so what ages?

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If other, How?

If medical provider, which one?

Please check the box if you do not want to be part of the Cancer and Pregnancy Registry.

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