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Cancer Services

Enhancing Health, Life & Survivorship

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Connect Now! Communication & Forms

Welcome! At Cancer Services, we are here to partner with you in your cancer journey. We are a community non-profit, so all our services are provided at no charge. Click the “Contact Us” button to connect with us for services. Filling out the information thoroughly helps us serve you best.

Contact Us to Connect for Services



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

We always keep your personal information private. Emails are used for communicating program information. You may unsubscribe at any time.

Forms in English

Forms can be filled out, saved, and returned by email to ptadvocate@cancerservicesonline.org or completed and submitted online, as available.

New Client Form – PDF

New Client Form – Financial Assistance – PDF

Statement of No Income Form – online form

Information Release Form – online form

Forms En Español

Formulario de nuevo cliente

Aplicacion Financiera

Divulgación de Información

Declaración de No Ingreso


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Cancer Services’ mission is to enhance health, life, and survivorship.

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United Way Partner Agency Guidestar Seal of Transparency Weston Award 2021



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3175 Maplewood Avenue Winston-Salem, NC 27103 | (336) 760-9983 | contact@CancerServicesOnline.org

Office Hours: Monday-Thursday 9am-4pm, Friday 9am-2pm

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