My Cancer. My Story. | Submission Form

First things first, which of the following best describes you?

Current patient undergoing treatment
Cancer survivor (completed treatment)
Caregiver/family member

Name

First Last

Date Of Birth

Sex

Male
Female

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone

Best way to contact you

Email
Phone
Other

Other

Cancer Type

Cancer Stage

Current Cancer Status

Did you receive tumor profiling by Caris Life Sciences?

Yes
No

Who was your treating Oncologist?

Did you and your physician choose treatment based on the molecular characteristics of your tumor?

Yes
No

Please provide a brief summary of your story below.

What piece of advice would you give other patients regarding molecular profiling?

Would you recommend tumor profiling?

Yes
No

By sharing your information with us, you agree that a Caris Life Sciences employee may contact you about using your story for Caris Life Sciences’ promotional activities.

Yes

The face behind the story.

Upload a photo of you/your family.