Skip to main content

Home
Young people
Parents & carers
- support for me
- support for my children
How we help
Support Canteen
Health & education
Research
About us
Cancer info
- Cancer types
- Cancer treatments

Accessibility

Find Information

Find information & support Donate now

Refer someone as a health or service professional

A professional female working on a laptop

/themes/canteencorp_main/images/access/hero.jpg

Connecting with Canteen services

Refer someone as a health or service professional

Make a referral

Youth Cancer Service

Fill the information below to refer someone as a health or service professional

Make a referral

If you’re ready to refer someone seeking support, please complete the form. By providing us with this information, we can connect your patient, student or client 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 with children aged 0-25 more easily access the different practical and emotional support services they need.

If you have questions about the services that Cancer Hub provides, please contact us instead of filling this form out.

Your Details

First Name

Last Name

Email

Phone Number

Hospital/Organisation Name

Start typing to search for your organisation. If not found you may enter the full name of your organisation.

Organisation ID

Role

Has the person you are referring given their consent to this referral?

YesNo

Please provide information about your enquiry

Details of person being referred

First Name

Last Name

DOB (DD/MM/YYYY)

Is the person you are referring under 16?

YesNo

Email

Phone Number

Country

State

Suburb

Postcode

Is the person you are referring Aboriginal and/or Torres Strait Islander?

Does the person you are referring require a language interpreter?

YesNo

Which language do they need an interpreter for?

Is the person you are referring a:

Young personParent or carerOther relationship to child/young person

Please select the option that best describes the person you are referring

AuntUncleGrandparentExtended family memberFriendOther

Please specify

Please select the option that best describes the cancer experience for the person you are referring

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

Please select the option that best describes the cancer experience for the person you are referring

I have cancer I survived cancer My child has cancer My child survived cancerMy child died from cancerMy partner/spouse has cancerMy partner/spouse survived 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 that the person you are referring needs

Who should we contact regarding support options?

The person being referred

MeSomeone else

Who should we contact regarding support options?

MeParent/guardian of the person being referred

Other Contact/Parent or Guardian Details

Please provide the details of the other person to be contacted about the support that Cancer Hub offers.

For a young person under 16, in order to process this referral please provide the contact details of their parent/guardian for additional contact regarding support options.

First Name

Last Name

Email

Phone Number

Relationship to the person seeking support

How did you hear about Canteen?

If Other, please enter how you heard about Canteen

reCAPTCHA helps prevent automated form spam.

The submit button will be disabled until you complete the CAPTCHA.

Follow us on :

About Canteen

Emergency links

Triple Zero
Lifeline
Kids Helpline

Helpful links

Contact us
Refer someone
Canteen Policies
Feedback & Complaints
Careers

PHONE ENQUIRIES

footer-small-image

Acknowledgement of Country

Canteen acknowledges Aboriginal and Torres Strait Islander peoples as the Traditional Custodians of this land. We pay respect to Elders past, present and future. We are committed to providing inclusive and appropriate support for Aboriginal and Torres Strait Islander young people, their kin and community. Indigenous Australians are respectfully advised this website may contain images, names or stories of people who have passed away. Read our Reconciliation Action Plan here.
Ngalaya (Dharawal for ally or friend in battle), is an artwork commissioned by Canteen created by Kamilaroi and Jerrinja woman and artist Jasmine Sarin.

footer-small-image

Diversity and Inclusion

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

75 King St, Newtown NSW 2042 Australia

© 2024 Canteen. All rights reserved. | Sitemap