Request a Mentor

  • As a Peer who is participating in a United Spinal Peer Mentoring Program, I understand that information obtained during Peer Mentoring sessions will be considered private and confidential.

    The information, however obtained, through direct interaction or digital transfer will remain with United Spinal and the Peer Mentoring Group providing the service. The information may be shared within the United Spinal Peer Mentoring Program with certain staff who are involved with the Peer or who have a need to know the information.

    At times, certain information may be used for purposes of performing program reviews or for developing program enhancements. At these times all identifying elements will be removed from the data prior to sharing.

    United Spinal will share data with legal authorities who duly request information in support of an investigation or legal action.

  • Emergency Contact

  • Personal Information

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