UNice

1. Your Name

2. Your Gender

3. age

4. Your Health Condition

5. Please share your journey in fighting cancer, your experiences, and any words of encouragement you'd like to offer to fellow patients

* 6. Would you be open to sharing your pictures and stories on UNice social media to inspire other cancer patients?

A. Yes

B. No, I prefer not to

7. Would you be willing to share your video and stories on UNice social media to support and encourage other cancer patients?

8. Your Email Address

9. Your Phone Number

10. Your Delivery Address

11. Your Social Media Accounts

submit

We will strictly protect your personal information, share stories and photos only with your explicit consent for positive energy dissemination, and dispose of your information appropriately after the event.