How to make a referral (health care professional)

To begin the registration process—or to make an enquiry—please submit the form below and we’ll email out the registration form.

If you are a social worker, cancer care or allied health professional you can refer a patient that meets the following criteria:

Must have a current diagnosis of cancer by an Australian Medical Specialist and be receiving specialist approved treatment.
Must have at least one child aged 12 years or under.

If you are a healthcare care professional or social worker please use the contact form below to receive a registration pack. This is the best and quickest way to get in touch with us. We appreciate your enquiry and will contact you as soon as possible.

How we can assist you?*
- I'm a cancer-care professional and need to make a referral (please provide your contact details only)
- I would like to enquire about your service
Name
First Last
Email
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Prefer to be contacted
- Telephone
- Email
Comments
Website enquiry
Phone
This field is for validation purposes and should be left unchanged.