Register for Cancer Rehab

Please take your time to read and complete the form below, ensuring your details are accurate before submitting. This helps us connect you with the most suitable provider. Once you have submitted the form, our Patient Navigator will be in touch within 7 business days.

Patient Details

Please tick the box that applies to you:

I want to register for individual sessions. I am ONLY interested in attending group programmes (Targeted Class, Next Steps, PaddleOn, Online class) and do not wish to register for individual sessions. I am interested in both individual sessions and group programmes.

Please complete the registration form below to be connected with a certified PINC & STEEL Oncology Physiotherapist.

PINC & STEEL is a charity-funded service and not government-funded. Due to high demand, funded sessions are limited. If you have insurance or are able to self-fund the initial assessment ($150), please indicate this on the form — this allows us to prioritise our charity funding for those who are unable to afford care.

Please select the relevant box:

I can self-fund the initial assessment cost ($150) I need funding assistance for the initial assessment

*required

I have Medical Insurance

Yes No

*required First Name

*required Last Name

*required Email Address

*required Phone Number

*required Gender

Age

Ethnicity

*required Street Address

Address Line 2 (Optional)

Suburb

City

Region

Please provide details about the type of support you are seeking

*required

Oncology History

*required Diagnosis

Diagnosis Date

*required Surgery

Type of Surgery

*required Radiotherapy

*required Chemotherapy

How did you hear about us?

Healthcare professional (e.g. oncologist, nurse) Friend, family member, or support group Social media Google/online search Other (please specify):

PINC & STEEL Registration