Client Forms

Click below to open each form in PDF format. Forms can be filled out, saved, and returned by email to ptadvocate@cancerservicesonline.org.

Questions? Call the office at 336-760-9983 and ask to speak to any Patient Advocate.

Forms in English

New Client Form

New Client Form – Financial Assistance

Statement of No Income Form – online form

Statement of No Income Form – fillable PDF

Information Release Form

Forms in Spanish

Formulario de nuevo cliente

Aplicacion Financiera

Recibo de Informacion

Declaración de No Ingreso