Welcome to Project THRIVE. Thank you for taking the time to register for this online cancer survivor reintegration programme, aimed at you and your family.
After registration, a link with access to the programme will be send to you to begin the modules. Once you have completed 2 modules, you will then be invited to participate in the Peer Support Group initiative, where regular meetings will be in place, to network and where cancer experiences and journeys can be shared. Someone in our team will contact you to assist with booking times for these sessions.
We hope you will find this support tool useful. If you have any questions, please contact: klfresearch@karenleungfoundation.org.
歡迎來到 THRIVE。感謝您寶貴時間註冊這個針對您和您的家人的線上癌症康復者重返社會計劃。
註冊後，您將收到一個附帶課程連結電郵，以開始使用相關課程。完成 2 個課程後，您將被邀請參加支持小組計劃，該計劃將定期舉行會議，建立聯繫網並分享抗癌經歷和歷程。我們團隊中一位成員將與您聯繫，以協助預訂這些會議的時間。
我們希望您會發現這個支援計劃很有用。如有任何疑問，請聯絡：klfresearch@karenleungfoundation.org。
Preferred Contact Method 首選聯絡方式 WhatsAppEmail 電郵Other 其他
Emergency Contact Name 緊急聯絡人姓名
Emergency Contact Relationship 緊急聯絡人關係
Emergency Contact Number 緊急聯絡電話
Please let us know which type of cancer you had/have 請告訴我們您曾經/現在有哪種癌症? (選擇多項)
Gynecological 婦科癌症Anal 肛門癌Breast 乳癌Cervical 子宮頸癌Laryngeal 喉嚨癌Ovarian 卵巢癌Oropharyngeal 口咽癌Rectal 直腸癌Uterine 子宮癌Vaginal 陰道癌Other 其他
What is your/your dependent diagnosis? 您/您的家屬診斷是甚麼?
When did you/your dependent get diagnosis? 您/您的家屬何時被診斷? (MM/DD/YYYY)
Cancer Stage / Level 癌症階段/程度
Stage 1 第一階段Stage 2 第二階段Stage 3 第三階段Stage 4 第四階段Other 其他
Treatment last date 治療最後日期 (MM/DD/YYYY)
Treatment Completed? 治療是否完成?
Yes 是No 不是Not Sure 不確定
If treatment is ongoing, where are you currently receiving your treatment? 如果治療正在進行中，您目前在哪裡接受治療?
Have you received hospitalization for substance abuse or self-harm in the last six months? 過去六個月內，您是否有因藥物濫用或自我傷害而住院?
Yes 有No 沒有
HERE is the full version of the consent form. By signing and dating this form, I confirm that:
I have read and understand this form and its contents were explained to me.
I understand there is no cost or payment for participating in this study and my participation in this clinical study is voluntary.
I can choose to withdraw from this study at any time.
All personal data collected will only be used for research purposes.
這是您簽名的同意書。本人確認在本同意書上簽字並註明日期，並確認:
本人已閱讀並理解本知情同意書，其中內容已向本人說明。
本人知道，參與本項研究不需繳納費用也不會獲得參與本項研究的報酬。
本人可隨時選擇退出此研究。
所有資料會保密處理，並只作研究用途。
I have read and fully understand the above information and agree to participate in this study. 我已閱讀並完全理解上述資料，並同意參與本研究。
Form Submission Date 表格提交日期 (MM/DD/YYYY) (required)
HKID/Passport 香港身份證/護照 (e.g. XXX456)
Please sign (Type your full name) 請簽名 (請輸入您的全名) (required)
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