ClusterBuddies Support Seeker Application

Thank you for connecting with our ClusterBuddies program as a Support Seeker.

ClusterBuddies is a one-on-one peer-to-peer support program. Clusterbusters knows that one of the greatest strengths of our community is how we connect with and support each other. ClusterBuddies formalizes the process of connecting those who are experienced in navigating our disease and community with those looking to connect for support. 

ClusterBuddies Support Givers are not medical professionals or mental health experts. Support Givers can share their own experiences with cluster headache and lessons that Clusterbusters has figured out over 20+ years of patient support. If you are in crisis, the best support is a qualified mental health professional.

We’d like some details about you to help us connect you with a suitable person that can share helpful information and give experienced support.

Please complete the questionnaire below and answer as many questions as you feel comfortable answering. Check as many boxes as you feel are appropriate. We will get back with you as soon as possible. 

If you have any questions, please reach out to clusterbuddies@clusterbusters.org

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Disclaimers: 

We know that being in-cycle can mean excruciating pain and feelings of despair. ClusterBuddies does not provide individuals with crisis support. Severe pain and depression can be life-threatening conditions because they may lead to suicidal feelings. One study found that the risk of suicide was significantly higher among people with cluster headache than the general population. If you are having thoughts about harming yourself or feel you are at risk of hurting yourself or someone else, call the National Crisis Hotline at 988 or 1-800-273-TALK (800-273-8255). For an emergency, call 911.

We know these emergency resources are not perfect - but this ClusterBuddy program is not capable of providing emergency support. It is a peer-to-peer support program. Not professional services for emergencies. 

Also, this program is not a substitute for medical care. We always strongly recommend seeking medical advice before making any changes to your treatment plan.  

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Required
First name/Nickname/Handle *
Last Name

What is your gender?


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Email address you prefer to be contacted at for this program: 
Mobile number you prefer to be contacted at for this program: (Include country code if outside the US)
Are you able to do video meetings/calls?
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Do you prefer to do video meetings/calls? 
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What is your preferred language for communications? (This program is primarily English-language focused, but we can try to make other language pairings where we can.)
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What is your preferred language other than English for for program communications? 
City
State/Province
Country

Have you been diagnosed with cluster headache?

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How many years ago were you first diagnosed with cluster headache?

Are your cluster headaches Episodic or Chronic? 
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Are you currently in cycle?
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How long have you had cluster headache? (This may  be different than how long you have been diagnosed)
In what areas are you seeking support and information? Check all that apply
Are you interested in learning more about any of the following treatment options? (Check all that apply)

Do you have a preference for gender of your Buddy?

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Preferred method of communication for follow up communications.
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Any information you want to share about yourself or what you are looking for in a Buddy?
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