Contact a Peer Mentor

Please tell us about yourself

Name

First

Last

The email address that the mentor should use

City

State

Which pronouns do you use?

She/her
He/him
They/them
Other

Select all that apply.

What date is your birthday?

Please complete your profile. This information will help your peer mentor learn more about you. Your information is confidential and will not be shared.

I agree to PHA’s Code of Conduct

I agree

PHA's Code of Conduct

I am a...

Why are you seeking peer support?

What is your preferred method of communication?

Phone
Email
No preference

What is your preferred language?

English
Spanish
Other

What year were you/your loved one diagnosed?

What is your employment status?

How did you find out about the Peer Mentor program?

Are you a member of PHA?

Yes
No

Your message to the selected mentor will be sent regardless of your answer.

Thank you for requesting a Peer Mentor.
Reach out to Support@PHAssociation.org if you have questions.
You will be return to the Peer Mentor page when you press the Submit button.

Contact a Peer Mentor

Contact a Peer Mentor

Pulmonary Hypertension Association

Support line

Email