Services & Forms

If you or a loved one are coping with a cancer diagnosis you are not alone. Cancer Services can help fill the gaps in available services and resources during your journey. Our services are available as an emergency supplement to those living with a cancer diagnosis. Thanks to the generosity of local community members and grant funding, there is no cost for any of the services we provide to cancer patients in our service area; Erie County, Huron County and Ottawa County. Our services are available at no cost to local cancer patients or their families through generous individual donors and the following generous funders:

Available Services

Nutrition Assistance
Transportation & Mileage Reimbursement
Medical Supplies & Equipment
Wig & Mastectomy Items
Education & Support Services

Registration and Reimbursement Forms:

For your convenience, you can download and print our forms. Please print clearly and complete the entire form. Please note: services are not available until a completed “Client Intake” form is received and approved. Mileage Reimbursement & Prescription Assistance programs are income-based. Income verification is required. If you have any questions regarding these forms or available services please call our office 419-626-4548. Our Patient Services Manager is available Monday – Friday 9 am – 3 pm.
Client Intake Form
Donation Form
Travel Reimbursement Request Form
Volunteer Info Form
Volunteer Application Form

Cancer Survivors:

When available through donated items, (items donated by community members) we can provide you with medical supplies and/or nutrition supplements, and comfort items during your transition to survivorship. Please note that donated items are not always available are should not be relied on by any client of Cancer Services.

A SPECIAL THANK YOU TO OUR YEAR ROUND CORPORATE SPONSOR: Beck Oil / Friendship! Their partnership with Cancer Services supports our Patient Services Program, daily operations and helps ensure that we can serve every cancer patient that comes through our door.