Consent Form

CancerBridge | Consent for Cancer Navigation and Support Services

I hereby voluntarily agree to participate in CancerBridge’s cancer navigation and support services. I understand that these services will include access to evidence-based educational offerings, expert cancer navigation regarding providers, innovations and new technologies, and insights into various treatment options.

I understand and agree that my participation in these services may require me to share certain health information with CancerBridge staff to enable them to provide me with such navigation and support services. CancerBridge staff will keep this information confidential, and will only use or share it to provide navigation and support services to me and my family.

I further understand that CancerBridge does not provide medical advice, diagnoses, medical consultations or treatments, order tests or prescribe medications.

I further understand that CancerBridge does not provide funding for nor coordinate or confirm any insurance benefits related to any cancer treatment or other medical care, and that I have been advised by CancerBridge to check with my insurance company to understand my cancer benefits and where I may be able to receive care prior to seeking CancerBridge’s services.

By signing this form, I acknowledge that I have read the consent form and that I understand the scope and limits of the services that CancerBridge can provide to me.