Counselling Grant Application Form

We provide free counselling to any member of the family to help them navigate the many aspects of cancer. Your doctor or oncology nurse can request this counselling for you by completing the form or you can self refer by contacting the Centre.

Cancer Support in Nelson/Tasman

Local Cancer Support Groups
Cancer Education
Support Grants
Counselling
Fitness & Lifestyle Support
Family Support
Other Support

Fill out our Counselling Grant Application Form

Counselling Grant Application Form

  • Applicants Details

  • Has this person received or requested support from: Social worker/counsellor(please detail)

  • Who is making this application?

    Name and position of person submitting this application on behalf of applicant: (Must be a health professional / social worker / Cancer Society staff member)
  • Please confirm the proposed recipient of this Grant is aware of this application and that all information is kept securely in accordance with the Privacy Act 1993:
  • Note: Anyone accepting a counselling grant is registered as a Cancer Society member
  • This field is for validation purposes and should be left unchanged.

Find out more about our support services

If you would like to find out more about our individual support services or join a support group please phone the Centre(03) 539 1137 or email us.

Contact us