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1800 431 312

Home
Services
Get Support
About
- In The Media
Resources
FAQs

Referring as a health or service professional?

Fill out the form

Get support from Cancer Hub

By providing us with this information, we can connect your family member or friend with the support services that best meet their needs.

Once you submit the form, someone from the Cancer Hub team will be in touch within 48 hours to discuss support options. Cancer Hub is a collaboration between Canteen, Camp Quality and Redkite to help families impacted by cancer more easily access the different practical and emotional support services they need.

Your Details

First Name

Last Name

Phone Number

Are you a:

Person seeking support
Family member or friend of someone seeking support

What is your relationship to the person seeking support

If the above options do not apply to you and/or you are a health or service professional, please use our service professional referral form.

Has the person you are seeking support for given their consent to this referral?

YesNo

Please provide any additional information about the support your family member or friend needs

Details of the person seeking support

First Name

Last Name

DOB

Phone Number

Country

State

Suburb

Postcode

Is the person seeking support Aboriginal and/or Torres Strait Islander?

Does the person seeking support require a language interpreter?

YesNo

Which language do they need an interpreter for?

Is the person seeking support a:

Young personParent or carerOther relationship to child/young person

Please select the option that best describes the cancer experience of the person seeking support

I have/had cancerMy sibling has/had cancer
My sibling died from cancerMy parent has/had cancerMy parent died from cancerOther

Please select the option that best describes the cancer experience of the person seeking support

I have/had cancerMy child has/had cancerMy child died from cancer
My partner/spouse has/had cancerMy partner/spouse died from cancerOther

Please provide information about the cancer experience of the person seeking support

Please provide any additional information about the support your family member or friend needs

Please enter any additional information about the cancer experience and current needs, best times to contact, and any relevant information that will help us determine the most appropriate services

Additional details

DOB

Country

State

Suburb

Postcode

Are you Aboriginal and/or Torres Strait Islander?

How do you describe your gender identity?

Do you require a language interpreter?

NoYes

Which language do you need an interpreter for?

Are you a:

Young personParent or carerOther relationship to child/young person

Please select the option that best describes your cancer experience

I have/had cancerMy sibling has/had cancerMy sibling died from cancerMy parent has/had cancerMy parent died from cancerOther

Please select the option that best describes your cancer experience

I have/had cancerMy child has/had cancerMy child died from cancer
My partner/spouse has/had cancerMy partner/spouse died from cancerOther

Please provide information about your cancer experience

Please provide any additional information about the support you need

Please enter any additional information about the cancer experience and current needs, best times to contact, and any relevant information that will help us determine the most appropriate services

How did you hear about Cancer Hub?

If Other, please enter how you heard about Cancer Hub

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1800 431 312

Acknowledgement of Country

We acknowledge Aboriginal and Torres Strait Islander peoples as Australia’s First Peoples and sovereign Custodians of this land. We pay our respects to Elders past, present and emerging. We are committed to providing inclusive and appropriate support for First Nations young people, their kin and community impacted by cancer. First Nations peoples are respectfully advised this website may contain images, names or stories of people who have passed away. Ngalaya (Dharawal for ally or friend in battle), is an artwork commissioned by Canteen created by Kamilaroi and Jerrinja woman and artist Jasmine Sarin.

Diversity and Inclusion

We are guided by our values and commitments to ensure that everyone at Cancer Hub feels respected, included and safe. We welcome the LGBTQI+ community and people from all cultures, backgrounds and abilities.

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