I understand that I will be paired with a Mentor who has completed cancer treatment or is in maintenance cancer therapy and is paired with me based upon several similarities such as cancer diagnosis, treatment type and special considerations I have identified (where possible).

I understand that my participation in NCS Peer Support Program is voluntary.

I understand that my NCS Peer Support Mentor is a layperson who cannot give medical, psychological, or legal advice.

I understand that information shared by a Mentor or Mentee is confidential and this confidentiality may be broken if there is concern of physical, psychological, emotional, or financial abuse or neglect to either party or an outside person identified as at-risk by the Mentor/Mentee.

I understand that my Mentor will be asked to maintain confidentiality of information I choose to share with him or her, but Nebraska Cancer Specialists is not liable for any breach of confidentiality.

I agree to complete a brief survey after the first contact with my Mentor to whom I am paired.

I understand that if I feel incompatible with my Mentor, I may elect to have another Mentor pairing or elect to withdraw from the program.

I understand the contact with my Mentor will either be via phone, email, or face-to-face in a public setting.