Request One-to-one support

Your details

First name *

Last name *

Getting in touch

Telephone number *

We will give you a call to discuss the One-to-one support service so please provide a number you are happy for us to call you back on.

Please tick the following boxes if you are happy for us to:

Leave a message if we can't get through to you

Say we're calling from Prostate Cancer UK if someone else picks up

Please choose the days of the week on which it would be best to contact you:

Monday

Tuesday

Wednesday

Thursday

Friday

The specialist nurse will call you back between 10am and 4pm Monday to Friday. If you contact us on a weekend, the specialist nurse will call you back the following Monday.

About you

Please tick any of the following that apply to you:

I have recently been diagnosed with prostate cancer - pre treatment

I am currently having treatment for prostate cancer

I have completed treatment for prostate cancer

I am a partner/family friend of a man recently diagnosed with prostate cancer

I am supporting a man living with prostate cancer (during or after treatment)

I have lost my partner/family/friend to prostate cancer

Privacy and confidentiality

By providing us with personal data, you consent to the collection and use of any information you provide in accordance with the above purposes and our privacy statement (link below). Any personal information supplied to the Specialist Nurses will be used for the purpose of dealing with your enquiry. We would only pass on identifying details in exceptional circumstances in order to comply with the law or the Nurses' Code of Conduct. For more information, see our confidentiality statement (link below).

prostatecanceruk.org/privacy
prostatecanceruk.org/confidentiality

Get in touch