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Chronic Disease:
Better Choices, Better Health: A Workshop for People with Long-Term Conditions

 

 

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Emergency Contact

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 Flyer
 Poster in clinic
 Provider referral
 Email
 Mail
 Supportive Care Program Calendar
 Other* (please fill out box below)
 
 
 Yes
 No
 
 
 
 

Disclaimer:
Stanford Health Care’s (SHC) Support Care Program is providing a forum for SHC staff and community members to participate in and offer support in a group setting. By registering for this support group, I acknowledge the following:

  1. SHC will not use, access, or disclose any of my protected health information during the sessions;
  2. SHC support group facilitators will take reasonable measures to safeguard the privacy of the support group sessions; however, I understand that this is a community-based group, and any information that I share, including personal and/ or health information, is not confidential and may be redisclosed; and
  3. I will take measures to protect my own privacy in this setting, including but not limited to:
    1. I will use just my first name during the support group sessions;
    2. I will not provide details about my address and/or physical location during the support group sessions; and
    3. I will limit the use of my personal and/or health information, or that of my friends and family members, to only what is necessary to participate in the support group.
    4. I will participate in the support group session in a private setting whenever possible.
 I agree
 I disagree

Please select "I agree", otherwise you will not be able to participate in the support group.