Get One-on-One Emotional Support

We connect those going through cancer treatment with cancer survivors. We also connect loved ones with others who have been caregivers. If you are interested in becoming connected with a cancer survivor or caregiver to receive general emotional support by phone or email, please complete the form below.

Please do not submit this form for someone else.

If you are seeking support for someone else,

please call our office – 888.461.0028.

Get Emotional Support

Patient/Family Member Details

Nurse Navigators, Social Workers, Healthcare Professionals, etc.: please contact our office at 888-461-0028 and speak with one of our staff members to refer your patients instead of using this form. Thank you.

My first name is *

My last name is *

I am a *

Patient

Family Member/Caregiver

Other

If you are not the patient, what is his/her relationship to you? (The patient is my _________________.) *

My age (must be 18+) *

Type of cancer and where it has spread (if applicable)? *

My gender *

Male

Female

Prefer not to answer

I want to talk about... *

Preferred phone number *

Please confirm phone number *

My email address *

I currently live *

inside the United States

outside the United States

Please provide your city and country *

City

State/Province

Zip/Postal

Country

My address *

City

State/Province

Zip/Postal

The CanCare staff will contact you to inform you of your volunteer or if clarification of your request is needed. Which method is the best way for our staff to contact you during business hours (central time)? *

Phone (this option is for US residents only)

Text (this option is for US residents only)

How do you prefer to be contacted by your one-on-one support volunteer? *

Phone (this option is for US residents only)

Have you requested support from CanCare before? *

Yes

If you were referred by medical staff, which hospital or facility is he/she associated with?

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Houston Rockets Power Dancer diagnosed with Hodgkins Lymphoma at age 21 shares her story, admitting, “I’m not the face of cancer.”

Want to avoid isolation and find your way back to a life without cancer? In times of crisis most people are better together than on their own. CanCare applies this simple truth on a daily basis by providing cancer survivors to encourage those anxiously embarking on a medical journey they did not choose to take. Want someone to pray with you? Regardless of your specific cancer, phase of life or religious affiliation, we know your experience with CanCare can be life changing.

Specific details will help us find the right volunteer for you.

Find your volunteer of hope today! After you have submitted your information on our secure and confidential form, a member of our staff will contact you soon.

CanCare connects patients with survivors – often sharing the same age, profession or family structure — who have experienced a similar/same diagnosis and treatment plan. Their stories and enthusiasm for life are contagious.