Refer a Young Adult

Help us eliminate isolation!

Young Adult Cancer Canada (YACC) is a national not-for-profit organization that provides digital, local, and national programs for young adult cancer patients and survivors diagnosed between the ages of 15-39 and aged between 18-39 years old. YACC also offers services to those supporting young adults living with cancer as long as they are aged between 18-39. If you are — or work with — a young adult who is eligible to our services, please fill out the form below and we will be in touch with more information about relevant services.

Required fields indicated with *

Name*
First Last
Email*
Enter Email Confirm Email
Phone number
City*
I am filling out this form on behalf of*
- Myself
- A patient
- Other
Please specify the role
What is the name of the person you are filling this form on behalf of?*
Diagnosis*
Age at Diagnosis*
Current Age
If you are a young adult dealing with cancer, are you still in active treatment?
- Yes
- No
When did you complete treatment?*
How did you hear about YACC?
CAPTCHA

Register with YACC

Help us eliminate isolation!

We LOVE our partners!