PH Buddy Program - Request a Buddy

Get Matched with a Buddy!

The PH Buddy Program matches you with someone from the PH community, a 'peer' who can understand what you are going through. Your 'buddy' can support you via email, phone or even in person. This program is for patients, caregivers and any friend or family member affected by PH.

Tell us a little about yourself, and you will be matched with a knowledgeable and experienced buddy who can help you navigate your PH diagnosis.

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* 1. First Name:

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* 2. Last Name:

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* 3. Email Address:

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* 4. Home Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Phone Number

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* 5. Gender:

Male

Female

Other (please specify)

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* 6. What is your age?

under 16 years

17 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 7. Are you a:

PH Patient (including post-surgical patients)

Caregiver, partner, friend, relative of someone with PH

Other (please specify)

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* 8. What type of PH have you/your care partner been diagnosed with?

WHO Group 1: Pulmonary Arterial Hypertension (PAH)

WHO Group 2: PH Associated with Left-Sided Heart Disease

WHO Group 3: PH Associated with Lung Disease

WHO Group 4: Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

WHO Group 5: PH Caused by Various Other Diseases

Unsure

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* 9. In what year were you or your loved one diagnosed with PH?

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* 10. What is your preferred way of connecting with your PH Buddy? (select all that apply)

video call (Facetime, Skype, Zoom)

phone

text or messenger

in-person

I have no preference

Other (please specify)

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* 11. What is most important to you when being matched with a 'Buddy' (please select all that apply)

My buddy is the same gender as me

My buddy lives close by or in the same province

My buddy has a similar diagnosis as me

PH Buddy Program - Request a Buddy

Get Matched with a Buddy!

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* 1. First Name:

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* 2. Last Name:

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* 3. Email Address:

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* 4. Home Address

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* 5. Gender:

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* 6. What is your age?

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* 7. Are you a:

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* 8. What type of PH have you/your care partner been diagnosed with?

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* 9. In what year were you or your loved one diagnosed with PH?

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* 10. What is your preferred way of connecting with your PH Buddy? (select all that apply)

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* 11. What is most important to you when being matched with a 'Buddy' (please select all that apply)

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* 12. Please tell us any other information that you think is important in helping us match you with your buddy.

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* 13. Do you want to receive emails on PH resources and news from PHA Canada?

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* 14. Do you want to receive our printed Connections magazine twice a year?