Share Your Story Every day millions impacted by colorectal cancer search online looking for stories of people who’ve also faced this disease. When you share your experience, you let others know they are not alone. Share on Facebook Share on LinkedIn Share on Twitter Copy this URL Share via Email Has Colorectal Cancer Impacted Your Life? We guarantee that when you share your story, you will inspire others. Plus, you’ll inform our team about the latest issues patients face. We’ll use your feedback when we create future blogs, webinars, podcasts, and other patient resources. Need some encouragement or inspiration to share your experience? Check out our library of stories from others who’ve gone before you. Comparte tu historia en español First Name Last Name Email Phone number: Address line 1 Address line 2 City StatePlease select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY Zip Ethnicity (select all that apply)American Indian or Alaskan Native AsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Pacific Islander White CaucasianPrefer not to answerOther If your ethnicity is not listed above, you may enter it here What is your connection to colorectal cancer (CRC)?Please select... Patient/Survivor Caregiver Family Member of Patient NOT Blood Relative Family Member of Patient Blood Relative Friend of Patient Medical Professional Advocate Other If you are a survivor or patient (or caregiver to a survivor or patient), please select whether you (or your loved one) received a colon or rectal cancer diagnosis and what stage you were at the time of diagnosis:Please select... Rectal - Stage I Rectal - Stage II Rectal - Stage III Rectal - Stage IV Colon - Stage I Colon - Stage II Colon - Stage III Colon - Stage IV Type of screening completed (select all that apply):Fecal Occult Blood Test (FOBT)Fecal Immunochemical Test (FIT)CologuardColonoscopyOther If you selected Other, please list: How old were you or your loved one at the time of diagnosis? Tell us about your diagnosis or your loved one's diagnosis. When did it happen, where were you when you got the news, and was anyone with you? (Patients, please include your stage at diagnosis) Ideal story length is 250+ words What were the symptoms that led you or your loved one to talk to your doctor about your concerns?Rectal bleeding or blood in stoolOngoing change in bowel habitsNarrow stoolsStomach cramps/bloating/fullnessUnexplained, sudden weight lossFatigueUnable to have a bowel movement (bowel obstruction) or constipationNo symptomsOther If you selected Other, please briefly describe Do you have easy access to affordable health care where you live? What type of treatment(s) did you receive?ChemotherapySurgeryRadiationOther If you selected Other, please describe Do you or your loved one have an ostomy?Please select... Yes No If you answered yes, please select the appropriate specifics about you or your loved one's ostomy experience:Please select... Colostomy Ileostomy Permanent Temporary Reversal surgery Are you or your loved one in active treatment?Please select... Yes No How long were you/have you (or your loved one) been in active treatment?Please select... 0-12 months 1-2 years 2-3 years 3-5 years 5+ years Please select side effects from the list below that you or your loved on experienced (or currently experience) as a result of treatment and/or surgery:FatigueBowel irregularitiesMouth soresChemo induced nausea and vomiting (CINV)LARSSecondary cancer(s)PainInfectionHigh blood pressureNeuropathyHand-foot syndromeSkin rashes (skin toxicity, chemo rash)Chemo brainDistress or mental health issues/illness Have you participated in a clinical trial?Please select... Yes No If you have participated in a clinical trial, tell us about your experience! If you haven't participated in a clinical trial, is there a reason why? What advice do you have for someone who might be afraid to seek medical advice or colorectal cancer screening? What tools, information, or resources have you found most helpful? What Fight CRC resources have you found helpful?Your Guide in the FightBeyond Blue magazineScreening Mini MagazineSkin Toxicity Mini MagazineClinical Trials Mini MagazineBiomarkers Mini MagazineBiosimilars Mini MagazineGenetics Mini MagazineSide Effects Mini MagazineSpanish resourcesWebinarsPodcasts What words of wisdom do you have for other relentless champions? Share some words of encouragement or advice you received that helped you Do we have your permission to send you occasional text messages?Please select... Yes No Would you like to receive emails on additional news about Fight CRC? (select all that apply)AdvocacyResearchWebinar AlertsFundraising OpportunitiesPatient EducationEventsMonthly Newsletters Please enter your social media handles if you'd like us to share them as part of your bio Facebook: Twitter: Instagram: YouTube: TikTok: Website/Blog: Would you like to be contacted about Fight CRC Volunteer Opportunities?YesNot at this time Please upload a recent photo of yourself (bonus points for a #StrongArmSelfie!) Use an image that is at least 300 pixels wide and 300 pixels tall If you are comfortable sharing, please upload a photo of yourself during treatment By submitting this form you agree to give us permission to potentially share your story on our blog or social media channel. Please check the box to acknowledge.I acknowledge that Fight CRC may share some of the information provided on this form on blogs or social media channels. reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. 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