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Request A Heart & Soul Coaching Session with CC

Coaching sessions are always free. Donations are welcome. 

Today's Date
Initial Contact: Which do you prefer?
Text via phone #
Email
Message via social medai
Call me
If located outside of the USA, what is the best way to reach you?
Are you a
Survivor
Caregiver
Other
What stage was the diagnosis?
1
2
3
4
Don't know
What phase of treatment are you/they in? (select all that apply)
What does your/their treatment plan include? (select all that apply)
CRC Survivors - Do you have LARS (lower anterior resection syndrome)?
Yes
No
I'm not sure
Do you have an ostomy?
Yes
No
Do you identify as part of the LGBTQIA2S+ Community? If yes, please check below. This is a Safe Space!
No. I do not identify as LGBTQIA2S+
Gay
Lesbian
Transgender
Bisexual
Queer
Intersex
Asexual
Non-binary
Gender neutral/gender fluid
Two Spirit
Prefer not to disclose
Other
Preferred Pronouns
Do you consider yourself to be... (This question is for my benefit and helps me be a better coach for you and make recommendations for tools, reading, methodologies, etc.)
I'm looking for (select all that apply)
Would you consider yourself to be more
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