Active Against Cancer, Harrogate and District NHS Trust

Healthcare professional referral

Access the service for your patient

Please note: Healthcare professionals can now refer via WebV. If you have access to WebV please refer via that method. Otherwise, continue with this form.

To be referred to Active Against Cancer, please confirm the patient meets the following criteria
Please confirm patient also meets one of the following conditions

If your patient does not meet these criteria please call 01423 557924 to discuss with a member of the Active Against Cancer team.

Name of referring health professional(Required)
Name of patient(Required)
DD slash MM slash YYYY
Stage of treatment(Required)
Known medical conditions
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