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Patient Support

Refer Myself or Whānau

Refer Yourself or Whānau

Refer a Patient

Cancer Information

If you are a new patient, whānau or a carer looking for support, please use the referral form below.

Alternatively, you can email us on support@gucancer.org.nz or call us on 0800 112 775 and talk to a member of our support team if you prefer.

We will be in touch as soon as possible to offer support.

Your Details

Title*

Your First Name*

Your Last Name*

Your Date of Birth*

Your Email Address*

Your Postcode*

Your Phone Number*

Your Gender*

Patient/ Carer information

Are you a patient, carer or other?*

Please tell us the type of upper gastrointestinal cancer (if known)*

Year of cancer diagnosis

Language & ethnicity

Country of Birth

Main/preferred language spoken at home

Will an interpreter be required?

Self-identified culture/ethnicity

Additional self-identified culture/ethnicity

If applicable, please list any iwi and/or hapū you whakapapa to or identify with

How can we help you?

Speak to a specialist cancer nurse

Assistance with care navigation

Emotional wellbeing & support

Other

Contact & privacy

What’s a good day and time for us to call you? (Leave blank if you prefer or tell us the best way to reach you)

How did you hear about us?

I consent to the collection, use, and disclosure of the information I have provided to Gut Cancer Foundation in accordance with the privacy policy at https://www.gutcancer.org.nz/privacy-policy/

I consent to receive marketing and communication emails from Gut Cancer Foundation. You may contact us to opt out at any time.

Address

Financial Support and assistance

Financial Support & assistance

Financial Support & assistancePūtea taupua me te āwhina

Travel and accommodation

Travel & accommodation

Travel & accommodationKautere me te nohowhare

Insurance and Legal Information

Insurance & Legal Information

Insurance & Legal InformationTe Inehua me ngā pārongoture

Advance Cancer Care Planning

Advance Cancer Care Planning

Advance Cancer Care PlanningWhakamahere maimoa whatutoto

PHYSICAL HEALTH

Physical Health

Physical HealthTaha tinana

ADVANCED CANCER CARE

Advanced Cancer Care

Advanced Cancer CareMaimoa whatutoto

Mental Health

Mental HealthTaha hinengaro

Family Health

Family HealthTaha whānau

Spiritual Health

Spiritual Health

Spiritual HealthTaha wairua

Complementary Therapy

Complementary Therapy

Complementary Therapy

Practicalities

PracticalitiesNgā ritenga waiwai

Your Care Team

Your Care TeamTō kāhui taurima

Gut Cancer Foundation

Terms and Conditions
Privacy Policy

Registered Charity: CC39174

Contact Us

Visit our Contact Us page or,
Phone: 0800 112 775
Email: info@gutcancer.org.nz

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Mailing Address

P.O Box 28723, Remuera
Auckland 1541
New Zealand

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