Cancer Society Supportive Care Self Referral 2021
  • In sending us this form you are confirming that you understand you are being referred to Cancer Society Auckland Northland (CS), a non-government organisation dedicated to help reduce the incidence of cancer and ensure the best cancer care in our region. CS services are provided free of charge to people affected by any type of cancer.

    Information on this form is used to determine the support required and may also be shared with health professionals involved in your care. CS will conform to the Rules set out in the Health Information Privacy code regarding holding and using this information.
    Please ensure all relevant details are completed on the form, as we need the information to provide safe and effective care.

    - No one is obliged to utilise CS services. A patient may decline or withdraw at any time.

    - All drivers in the driving service are volunteers.

    - You may be contacted from time to time and given information regarding specific CS activities, for example by newsletter or group updates, unless otherwise requested.
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