Support Group-Parents of a Child Living with Graft-versus-Host Disease (GVHD) - 10-18-2023

Support group is for parents with a Pediatric child, age 0-18, who is living with Graft-versus-Host Disease (GVHD).

This Open Parent Group meets on the 2^nd and 4^th Wednesday of each month

7:00-8:15 pm Eastern, 6:00-7:15 pm Central,

5:00-6:15 pm Mountain, 4:00-5:15 pm Pacific

Caregiver for pediatric GVHD patient

Email (Primary) *

First Name *

Last Name *

This support group is only for Caregivers

Relationship to Patient *

Street Address (Home)

Supplemental Address 1 (Home)

City (Home)

Postal Code (Home) *

Phone-Cell

Phone-Home

Birth Year *

Please enter your birth year. Feel free to use Jan 01 for the month and year if you would like.

Gender

Female Male Gender Variant/Non-Conforming Prefer Not to Answer

If the diagnosis was not listed above enter below:

Disease Description

Date of Most Recent Transplant *

Enter mm/dd/yyyy

Transplant Center Formal Name

Transplant Type *

Donor type *

Type of cells used

Does the Patient Currently have GVHD *

Yes No

The Severity of GVHD *

Mild Moderate Severe

GVHD Organs (select all affected organs)

Has GVHD affected relationships *

Yes, a lot

Yes, a little

Not at all

What do you hope to get out of support group

I agree to keep confidential the names and comments of all people who participate in the group discussions. *

Yes No

If you have any questions registering phone 888-597-7674 for help or email Michala@bmtinfonet.org

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