Please note, this form is for healthcare professionals who want to make a referral to Cancer Coach. If you want to refer yourself to Cancer Coach please follow this link to complete the application form.
To refer an individual to Cancer Coach, please answer the questions below and complete the referral form on the next page. If Cancer Coach groups are suitable for the individual, someone from Cancer Support UK will get in touch with them directly to give them further information and ensure Cancer Coach is the right kind of support for them.
Please note that Cancer Coach groups are suitable for people who have previously had a stage 1-3 diagnosis.
All of the information you provide here will be kept confidential and will not be shared with anyone outside of the charity.