If you would like to connect with other patients and survivors, please fill out the form below. Once you have filled out the form, we will contact you by phone or email to confirm your details. We will then post your story to the I’m Living Proof map. We do not post your email address or telephone number. If you have questions or would like assistance with the process of sharing your story, please contact us at email@example.com.
Thank you for sharing your story with us. Hand in hand, we fight melanoma together.