Triage Cancer Materials Request Form
Please complete the following request form to order educational materials from Triage Cancer. Please allow for 2 weeks for materials to arrive. For questions, please email info@TriageCancer.org.
Please note: the materials listed below are the ones currently available for shipping. You can also print copies of these materials from our website. To see the full library of resources visit
http://triagecancer.org/resources
.
If you would like fewer than 25 copies of a resource, consider printing them from the website, to help us save on shipping costs. Thanks!
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First Name
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Last Name
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Hospital/Organization
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Shipping Address: Street Number and Name
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City
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State
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Zip code
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Email
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Phone Number (for questions)
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Please share how these materials will be used.
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Guides, Quick Guides, & Checklists - Please identify the quantity that you are requesting, by topic. If you would like custom amounts, please note amounts below.
25
50
Other (more than 50 - please indicate # below)
Practical Guide to Cancer Rights
Access to Medical Records
ADA & Reasonable Accommodations
Appeals: Individual & Employer Plans
Avoiding Financial Toxicity - Checklist
Caregiving
Chemo Brain
Clinical Trials
COVID-19 - Checklist
COBRA
Crowdfunding
Disability Insurance
Disclosure, Privacy & Medical Certification
Estate Planning
Fertility Preservation
FMLA Expanded
Getting Organized - Checklist
Health Insurance Basics
Health Insurance Options
Health Insurance Marketplaces
How FMLA Works With Other Benefits
Legal Assistance
Life Insurance
Managing Medical Bills
Medicare 2021
Medicare Basics
Medicare Savings Program
Medigap Plans
Navigating SSDI & SSI
Options for Losing Employer-Sponsored Health Insurance
Reasonable Accommodations - Checklist
Returning to Work
State Disability Insurance (CA, HI, NJ, NY, RI, PR)
Timing of SSDI & Medicare Benefits
25
50
Other (more than 50 - please indicate # below)
Practical Guide to Cancer Rights
Access to Medical Records
ADA & Reasonable Accommodations
Appeals: Individual & Employer Plans
Avoiding Financial Toxicity - Checklist
Caregiving
Chemo Brain
Clinical Trials
COVID-19 - Checklist
COBRA
Crowdfunding
Disability Insurance
Disclosure, Privacy & Medical Certification
Estate Planning
Fertility Preservation
FMLA Expanded
Getting Organized - Checklist
Health Insurance Basics
Health Insurance Options
Health Insurance Marketplaces
How FMLA Works With Other Benefits
Legal Assistance
Life Insurance
Managing Medical Bills
Medicare 2021
Medicare Basics
Medicare Savings Program
Medigap Plans
Navigating SSDI & SSI
Options for Losing Employer-Sponsored Health Insurance
Reasonable Accommodations - Checklist
Returning to Work
State Disability Insurance (CA, HI, NJ, NY, RI, PR)
Timing of SSDI & Medicare Benefits
Custom amount requested
Your answer
Spanish Quick Guides & Checklists - Please identify the quantity that you are requesting, by topic. If you would like custom amounts, please note amounts below.
25
50
Other (please indicate # below)
Reasonable Accommodations - Checklist
COBRA
Disability Insurance
Estate Planning
FMLA Expanded
Health Insurance Options
Health Insurance Basics
Managing Medical Bills
25
50
Other (please indicate # below)
Reasonable Accommodations - Checklist
COBRA
Disability Insurance
Estate Planning
FMLA Expanded
Health Insurance Options
Health Insurance Basics
Managing Medical Bills
Custom amount requested
Your answer
Flyers - Please identify the quantity that you are requesting, by topic. If you would like custom amounts, please note amounts below.
25
50
100
Other (please indicate # below)
Information Sheet / How Triage Cancer Can Help
Webinar Flyer
25
50
100
Other (please indicate # below)
Information Sheet / How Triage Cancer Can Help
Webinar Flyer
Custom amount requested
Your answer
Postcards - Please identify the quantity that you are requesting below.
25
50
100
CancerFinances.org
Animated Videos (English & Spanish)
Managing Finances Video
25
50
100
CancerFinances.org
Animated Videos (English & Spanish)
Managing Finances Video
Clear selection
Custom amount requested
Your answer
Drug Discount Cards - Please identify the quantity that you are requesting below.
25
50
100
Drug Discount Cards
25
50
100
Drug Discount Cards
Clear selection
Custom amount requested
Your answer
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