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Home
Looking for help?
Self Referral Form
Online Resources
Our Therapies
Children & Young People’s Service
Cancer buddies
Cavendish Wellbeing
Meet the team
Working with Cancer Pledge
Cancer Info Hub
Donate
Monthly Giving
Leave a Helping Hand…
Join our lottery
Christmas Cracker 2023
News & events
Events calendar
Cavendish stories
Get involved
Fundraise for us
Volunteer for us
Corporate partnerships
Job vacancies
Team Up, Game On
Christmas Fundraising
Tel:
0114 2784600
Donate
Contact Us
Self Referral Form
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Self Referral Form
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Full Name
*
Address (inc postcode)
*
Email
Telephone Number
*
Can we leave a voicemail ?
*
Yes
No
Can we text you ?
*
Yes
No
Date of birth
*
Have you been supported by Cavendish before?
*
Yes
No
Which of the following best describes you?
*
I'm a cancer patient
I'm supporting a family member with cancer
Something else
If 'something else', please tell us a little more:
Name of GP/Practice ( We will only contact your GP with your consent)
*
Diagnosis/type of cancer
Date of Diagnosis
Hospital Treated at/Consultants name
When is a good time to call you back?
Our reception operates Mon-Fri 9.30 - 5.30 please tell us when is a good time to try and get back to you
Morning
Afternoon
Or let us know a specific time
On any particular day? (tick all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
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