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Apply for support

A referral to support can be submitted by anyone including yourself, a friend, family member, colleague or health professional.

Step 1

Following a referral, complete an application with our support coordinators and supply some details.

Step 2

Verify your cancer diagnosis.

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Step 3

Verify your Pilbara address.

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A cancer diagnosis is not an automatic approval of a request for support. Eligibility and availability of resources at the time of application will be assessed within the context of other support services and family resources available to individuals.

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To be eligible for assistance, applicants must be undergoing active treatment or management of a confirmed and current cancer diagnosis and be residing within the Pilbara Region.

Begin your application process here

Please follow the prompts below to submit a referral. Upon receival, your nearest support coordinator will be in contact to assist you with the rest.

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Referral Form

Are you completing this referral on behalf of someone else?
Please indicate the current stage of your treatment
Patient town of residence
Does the patient identify as Aboriginal or Torres Strait Islander?
Patient Gender
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