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01
Personal Information
02
Personal Situation
03
Support Needs & Communication Preferences
04
Availability & Contact preferences
05
Legal & Consent
06
Password
Profile Picture
First Name
*
Last Name
*
Birthday
*
Gender
Select Gender
Male
Female
Other
Email
*
Phone Number
Address
*
Postal Code
*
Country
*
City
Marital Status
*
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Single
Married
Divorced
Widowed
Separated
Prefer not to say
Do you have children?
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Yes
No
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Profession
Current Professional Status
*
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Employed
Unemployed
Self Employed
Student
Retired
Other
Employment Percentage
We use this info to adapt return-to-work or social support programs
What kind of support are you looking for?
Help understand how healthcare system works
Help navigating the healthcare system and building a support network
Coordination of my medical care
Understanding medical information
Emotional support
Social support (housing, finances, family situation, etc.)
Support for returning to work
Connection with peer groups or communities
I'm not sure yet
Other, tell us in your own words
You can skip this and complete it later in your profile
Is there anything specific you'd like us to know about your situation?
Spoken Languages
*
Preferred language for health-related conversations?
*
Communication Language with our team?
*
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Arabic
English
French
Spanish
When are you usually available?
Day
Morning (08:00-12:00)
Afternoon (13:00-17:00)
Evening (17:00-20:00)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
My availability varies
Preferred Contact Methods
*
Phone
Email
SMS
Messaging via the app
Video call
I'll initiate contact when needed
You can always come back later to complete or update your profile. The more we know, the better we can support you — but you are always in control
I confirm that I am at least 16 years old.
*
If you are under 16, please do not complete this form. Use our [contact form], and our team will support you directly
I have read and accept the [Terms of Use] and [Privacy Policy]
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These documents explain how your personal data is used and protected.
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I agree to share my caregiver contact information for support purposes
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Your data belongs to you. We4Care is an independent service created by healthcare and social care professionals, all bound by strict professional confidentiality. We do not share your information without your explicit consent, and we are committed to protecting your privacy at every step.
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We4Care by your side
We4Care by your side
We4Care by your side