CTC Cancer Comfort Kit Order Form
These Kits are meant for any patient diagnosed with cancer in any stage of treatment. The Cancer Comfort Kits will be available to order twice a year. The deadline for the orders will be January 21, 2020. Any questions, please email
or call the office at 484-301-3047.
*Kits will be mailed out or delivered the week of February 10, 2020.*
Contact Name and Title
Contact Phone Number
Hospital or Cancer Center Name
Delivery/Shipping Address (Please Be Specific)
Number of Boxes (Note: 25 Cancer Comfort Kits per Box)
1 Box (25 Bogs)
2 Boxes (50 Bags)
3 Boxes (75 Bags)
4 Boxes (100 Bags)
5 boxes (125 Bags)
6 boxes (150 Bags)
7 Boxes (175 Bags)
8 Boxes (200 Bags)
What department are you ordering these kits for?
How many new patients do you typically see each month?
Is there anyone else at your hospital/cancer center we should contact to offer these Cancer Comfort Kits?
Send me a copy of my responses.
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