top of page

Medical Staff Referrals

Who we help:

  • Currently being treated for a cancer diagnosis

  • 18 years or older

  • Affected by one or more of the following:

  • Extended inpatient stay

  • Difficult economic circumstances

  • Difficult emotional circumstances

  • Severe side effects

  • Treatment is far from patient's home

Medical Staff Referral Form

**Spaces not guaranteed 

**Small Choices will contact patient within a week of receiving referral

Select which Program(s) You're Recommending Your Patient For

Thanks for submitting!

bottom of page