We are very sorry to hear of the diagnosis of your loved one. We'd like to hear your story; your experience and that of your loved one who bravely fought or is in the process of fight the cancer .

As a cancer researcher and long term brain cancer (GBM) survivor, I'd like to learn more than just how you he/she was or is being treated by the health care team but also what he/she did in the time since diagnosis and share with others. 

​Please fill out the form below and a formatted document will follow by email for your records, or to provide to your health care team.

Personal information will not be shared.  One aim as a cancer scientist, is to do a statistical analysis of various groups of data which will be shared here and/or through email. Your information is crucial. Another goal is to inform the brain cancer community on what people are doing in various dimensions to tackle this experience. If you choose to receive updates on this and/or new discoveries and treatments, leave "Do you wish to stay in touch?​" select below.
Note: There's a limited number of required fields indicated by a red star beside field name. Some field names have question mark--hover over for more information or instructions.To your level of comfort, please feel free to fill out other boxes which helps us learn more about your experience and treatment that was given.

    Tell us about your loved on.
    All of above (this section) is confidential and will not be shared with any third party without your permission. Statistical analysis may make use of city/country but nothing tied to personal information.

    Diagnosis and Treatment.

    What your loved one did to heal.

    Recurrence.

    If there was a recurrence of the cancer, please add details if you wish.

    Moving Forward.

    Summarize and add to your story...

    Almost Done!

    Submit.

    If you would like to send photo(s) to accompany your story, please send to:
    [email protected]

    Please add your full name or nickname in content of email to ensure photos are tied to your story.
    ​
    Soon after submission of your information, you will get a summary document to use for your records.  If you'd like to make changes to your initial submission, please email.

    You can play a role in helping with this effort; if there are things that are important and missing in this form please add to comments box above. 

    Don't forget to press SUBMIT below!

Thank you.


​My sincere condolences for your loss.

May the memories of your blessed loved one give you strength.  
A candle loses nothing
by lighting another candle.
                                Father James Keller