Rare Cancer Alliance Validation Form

Rare Adult Cancer & Pediatric Cancer Support
Rare adult cancer & childhood cancer patients/survivors, & their caregivers/loved ones are welcome. We offer support, treatment information, cancer specific medical experiences, and physician/facility information. Please be respectful of others.

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FAQ

Confidental Member Validation Form

Data will be kept strictly confidential and used for validation purposes only.
Validation is a human process. Allow 24 - 48 hours for activation.

Please enter general information about the patient.

* Input Required For Validation

Your Forum Username: *
Your E-mail Address: *
Diagnosis: *

Treatments, To Date:
(If newly diagnosed, enter information about how
your diagnosis was made.) *

Summarize Cancer (Tumor) Journey & Support Needs:
You must include descriptive info here. *

Your Relationship to Patient (if you, enter self): *

Type the numbers you see in the image below in this box:

Validation Form Security Code

You will be redirected to the forum home page.