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Your Information

First Name*

Last Name*

Preferred Phone*

Organization Code*

Your Experience

Which of these best explains why you are signing up to Naviance today?*

I am concerned about my cancer risk

I have been recently diagnosed with cancer

I am going through cancer treatment

I have finished my cancer treatment

I am a caregiver of someone with cancer

I am a manager of someone impacted by cancer

None of the above fit me

What is most important for us to help you with? (Select all that apply)

Reducing my cancer risk (screenings, lifestyle factors, family history)

Learning what to expect from a cancer diagnosis and treatment

Managing side effects during and after treatment

Managing work during and after treatment

Finding the right community support

Finding financial and/or legal support

Accessing emotional support, coping skills and self-care tips

Preparing for appointments with my medical team

Finding the right clinical resources

Communicating to family and/or colleagues

Other

Where did you hear about the Naviance program?*

Colleague

Company email/newsletter

Employer benefits fair

Family member or friend

HR representative

Manager

Webinar

Workplace benefits site

Workplace champion

Other

Account Information

Email*

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Password

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