Honor Your Ovarcomer

Honor your beloved Ovarcomer. We invite you to make a coantribution in honor and in memory of your loved one. By making a donation, you are supporting our critical mission of raising global awareness, funding breakthrough research, and providing financial, psycho-social and informational assistance to our Ovarcomers.

Your loved one’s legacy lives on through this donation. Together We Ovarcome.

Your Name: *
Mobile Number: *
Ovarcomer’s Name: *
Donation type: *
Photo (optional):
Dedication statement: *
Dedication Story: *
Please add my Ovarcomers Hall of Hope to the Ovarcomers Hall of Hope: *	YesNo

Via OvarCare Counseling we are pleased to offer: Up to 6 sessions of support for up to 6 months Meetings by phone in any location in the U.S. Supportive services to OvarCare grant recipients Information, resources, referrals as needed and requested Our OvarCare counseling sessions are designed to provide support through the journey of Ovarcoming Ovarian Cancer and are not deemed to be psychotherapy services. Our members are ready to provide compassionate and meaningful support via active listening, providing gentle guidance in navigating the often-challenging course of diagnosis, treatment and survivorship, and in providing effective tools and resources to Ovarcome. Please complete the fields below to register for our counseling program: We are here to Ovarcome with you. Welcome to our safe and friendly space. This is a complimentary service as part of our OvarCare Program and is currently available in English only.
Information
Name: *
Date of birth: *
Email Address: *
Address: *
Do you consent to receiving text messages from your OvarCare Support Services?: *	YesNo
Share with us the best way to reach you: *	EmailPhoneText MessageAll of the above
Primary Phone Type: *	MobileLandline
Please indicate your time zone: *	Eastern TimeCentral TimeMountain TimePacific Time Hawaii-Aleutian Time
What do you wish to accomplish from these support sessions? Please share your personal goal: *
Please carefully review the acknowledgements below: 1. OvarCare support services are designed to provide emotional and informational support and is not intended to provide any medical guidance. It is also not intended to provide psychotherapy, crisis management critical mental health issues2. You will be offered up to 6 counseling sessions for up to 6 months as part of this program. You will be contacted via the information you provide to us. Ovarcome is not responsible to maintain privacy of information if provided outside of the channels indicated on the form3. You agree to indemnify, defend, release and hold harmless Ovarcome, their employees, officers, directors, agents, successors and assigns, against all liabilities, claims, causes of action, damages, judgments, costs or expenses, including attorney's fees, caused by, resulting from or which arise in connection with your participation in OvarCare Support Services Program
Acknowledgement of My Consent BY CHECKING THIS CONSENT, I CERTIFY THAT: I have carefully read and consent to the terms and conditions stated herein.
Name: *
Date: *

Celebrate Your Ovarcomer. Donate in Honor. Donate in Memory

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