Patti Robinson Kaufmann
First Connection
Program
Want to Talk With Someone Who Has Been There? Fill in the below information to request to talk with a blood cancer survivor.
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First Name:
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Last Name:
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Date of Birth:
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Sex:
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Diagnosis:
Acute Myeloid leukemia (AML)
Chronic Myeloid leukemia (CML)
Myelo-dysplastic syndrome (MDS)
Acute Lymphoblastic leukemia (ALL)
Chronic Lymphoblastic leukemia (CLL)
Hodgkin's lymphoma (HL)
Non-Hodgkin's lymphoma (NHL)
Myeloma
Additional Diagnosis:
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List of Treatments:
comments/questions:
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Indicates Response Required
The Leukemia & Lymphoma Society
Upstate New York/ Vermont Chapter
Michael L. Grignon
Patient Services Manager
tel: (518)438-3583
toll free: 866-255-3583
email: michael.grignon@lls.org
www.LLS.org