MENTEE QUESTIONNAIRE

DISCLAIMER

The TransplantTalk SC Mentor/Mentee program was established to help primarily pre-transplant patients cope with issues that may arise as they navigate the Transplant Path. As mentors who have had organ transplants, we have been down that Path and want to freely offer to mentees the experiences we faced that might help them. Patients are given the chance to ask questions and talk about their emotions and feelings that they are experiencing in their time of uncertainty and unrest as they navigate the Path. 

It is important that the patient understands and realizes that TransplantTalk SC mentors are not mental health providers nor will they offer any medical advice.  TransplantTalk SC is an independent community based 501c3 not for profit organization and has no official nor legal affiliation with Medical University of South Carolina (MUSC) or any of its employees. This one-on-one communication by the mentee and mentor can only be offered by someone who has experienced navigating the transplant path.  The majority of us mentors never had a mentor as we went down that Path, but would have preferred one.  We hope that we can ease the comfort level through this relationship given many of the issues faced will be similar.  

TransplantTalk SC Mentors will try at all times to maintain complete confidentiality with our mentees, but please understand that if at any time the TransplantTalk SC mentors notice, or suspect any “Red Flags” during a conversation and/or they reasonably feel that the mentee is a danger to themselves or others, the proper steps will be taken in accordance with the law.  The Mentor/Mentee relationship could end immediately.  

Requesting a mentor is certainly not a requirement for a patients transplant listing.  This is a service that is being offered and a patient can withdraw from the program at any time for any reason.  We ask that the following questionnaire be filled out to the best of the patients’ knowledge in the attempt to match the patient with the best possible mentor.  TransplantTalk SC will attempt to match mentor with mentees by organ type.  In the event that a mentor is not available for a specific organ, the patient will be notified and offered a different mentor, given the patients’ approval.

By signing below, the patient, or guardian, affirms that they have read and understand the above and enter into the TransplantTalk SC Mentor/Mentee program willingly and can opt out at any time.  At no time will TransplantTalk SC charge or expect compensation of any kind.

Thank you so much!  We look forward to help you navigate the Transplant Path.

Note:  After you have filled out the form, hit send.  I will receive the form and assign a Mentor to follow-up by contacting you via the method you requested on the form.  If you have questions, please feel free to communicate with me.  Below is my contact information:

Gary Simmons, Liver Recipient 2013

Phone/text – 704-699-3046

e-mail – www.transplanttalksc@gmail.com

Address:  235 Bateaux Dr., Summerville, SC 29483.