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One Mile at a Time Transportation Program
Applicant Eligibility
I am:
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🛈
I am in treatment for a blood cancer
I am a caregiver
Eligibility criteria
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I reside in Canada
I have a blood cancer diagnosis
I have a minimum of 4 medical appointments related to my blood cancer diagnosis at a recognized cancer treatment facility in Canada.
I can provide a medical appointment schedule or email/note from a health care professional stating I still have a minimum of 4 medical appointments at a cancer center.
Eligibility criteria
The person I am applying for:
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🛈
Resides in Canada
Has a blood cancer diagnosis
Has a minimum of 4 medical appointments still required related to his or her blood cancer diagnosis at a recognized cancer treatment facility in Canada.
Has a medical appointment schedule or email/note from a health care professional stating he or she will have at least a minimum of 4 medical appointment at a cancer center.
Please attach appointment schedule, or email or letter.
Applicant Details
Details on caregiver
Full Name
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Email
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Phone Number (Home)
Phone Number (Cell)
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Mailing Adress
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City
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Province
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Nova Scotia
New Brunswick
Prince Edward Island
Newfoundland & Labrador
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
Date of Birth
*
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+
Diagnosis
*
Name of Cancer Treatment
*
Date of Diagnosis
*
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Details on person applying for the program
Full Name
*
City
*
Province
*
Nova Scotia
New Brunswick
Prince Edward Island
Newfoundland & Labrador
British Columbia
Alberta
Saskatchewan
Manitoba
Ontario
Quebec
Date of Birth
*
🛈
+
Diagnosis
*
Name of Cancer Treatment
*
Date of Diagnosis
*
🛈
+
Staying connected with the LLSC
I would like more information on:
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Blood cancers (LLSC print materials, online resources)
Information Resource Center (Medical information, clinical trials, nutrition support)
Practical support programs (financial assistance)
Psychosocial support programs (First Connection, support groups, mental health resources, Your Life After Cancer program)
Upcoming LLSC patient education session (webcasts)
I would like to receive communications about LLSC’s programs and services.
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Yes
No
I understand that the confidential information will be utilized by the LLSC for program management purposes.
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I agree
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National Office location
804 - 2 Lansing Square, Toronto, ON M2J 4P8
1-877-668-8326 EN
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1-866-637-0281 FR
Lightthenight_ONO@lls.org
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