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Contact & Consent Form:

Burn Survivor Peer Support Group

Royal Jubilee Hospital
Burn Survivor Contact Form

Thank you for reaching out to the Burn Survivor Peer Support Group, a compassionate initiative by the Firefighters Burn Fund Victoria in collaboration with the BC Professional Burn Fund. This program offers a safe and supportive space for burn survivors to connect, share experiences, and navigate the journey of healing together.

Please complete this form to connect with our peer support team and provide consent to participate in the program. Your privacy and comfort are our top priorities. All information will be treated with the utmost confidentiality.

We’re here to support you every step of the way.

Contact us

Gender
Treatment received at:*
I am interested in:*
Do you give permission to be contacted by the Firefighters Burn Fund Victoria, BC (FFBFVBC) and/or the BC Professional Fire Fighters’ Burn Fund (BCPFFBF):*
By completing this form I consent to share information with both Fire Fighter’s Burn Fund Victoria, BC (FFBFBC)
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