Financial Assistance Referral Form

Support for your clients

Financial Assistance aims to support clients who are undertaking treatment for cancer, experiencing financial hardship and are at risk of not participating in treatment. Eligible clients can receive financial assistance and/or referral to an appropriate internal and/or external service.

Eligibility is confirmed by a health professional following a thorough assessment of the client’s financial and social situation. Before completing the referral, please read the Financial Assistance Guidelines and Frequently Asked Questions.

You will receive an email confirming your successful submission of a referral. If you do not receive this email, please check your form for errors and resubmit.

Please note, approval for assistance is not guaranteed and will be at the discretion of Cancer Council Queensland and subject to availability. Applications are treated as confidential.

Telstra Bill Assistance Program

We regret to advise that the Telstra Bill Assistance Program has been phased out. Telstra has decided to change its processes and Telstra vouchers will no longer be available through our financial assistance program.

Telstra Customers can call Telstra on 1800 531 951 for support options. They can also do this through the My Telstra app on their smartphones, or via a web form at http://telstra.com/hardship.

Digital Gift Cards

We have introduced digital gift cards to Financial Assistance. Those approved for a food or fuel gift card will now receive their card by email. This will allow the client to access their gift card immediately. Once received, the client can save the card to use on their phone, or print out the card and carry it with them.

If the client does not have access to email, you can request a print-out of the card to be sent by registered post to you or your client (this will have a waiting period and require a signature on delivery).

If you have any questions regarding eligibility or accessing the digital cards, please email practicalsupport@cancerqld.org.au or phone 13 11 20.

Support during Holiday Season

Health professionals can continue to submit online requests for Financial Assistance over the Holiday period. Referrals received after 5pm Friday December 16, 2022, will be processed from Tuesday January 3, 2023.

  • This referral form must be completed by a health professional on behalf of the client.

  • Referrer Information

  • Client Information

  • Your Personal Information and your Client’s Personal Information is being collected by Cancer Council Queensland (ACN 009 784 356) (“Cancer Council”, “we”, “us”, or “our) [www.cancerqld.org.au], to facilitate services or products requested by you for your Client. Your Client’s Personal Information may be passed to a third party if Accommodation Assistance is being requested. Please refer to our Privacy Policy (which is available at the website above or on request by calling 13 11 20) for further details. Our Privacy Policy explains how you can contact us to access and correct your personal information or make a privacy complaint.

    Please ensure that your Client is given an opportunity to read Cancer Council Queensland’s collection statement before you submit their personal information.

     

    Please read the Financial Assist Guidelines.

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Health Professional Cancer Network