Blood Cancer UK Clinical Trials Support Service referral

Our Clinical Trials Support nurses are available Monday to Friday (except Bank holidays). If you'd like to get in touch, please complete the referral form below.

Referral form

(* are essential fields for the form to be submitted)

At Blood Cancer UK our Clinical Trials Support Team provides personalised support to anyone affected by blood cancer about clinical trials. To help us achieve this goal, we ask for optional diversity information and health-related questions. We take your privacy seriously and comply with GDPR regulations to protect your personal information. Please read our Privacy Policy for more information.

Back to Clinical Trials Support Service

Your first name *

Your last name *

Your email address *

Your phone

Email‑only support

Please only click the button above if you would like to receive all ongoing support by email. (This can be changed at any time)

Your postcode

Who is this referral for? *

Myself
My family member
My friend
My patient (Healthcare professional referral)
Other (please tell us in the additional information box below)

What type of blood cancer? *

We've tried to cover everything but if your blood cancer is not listed please select 'Other not listed' and let us know in the additional information box

How would you describe your (or their) current condition? *

Other situation (If none of the above describe your current situation, please tell us below)

Have clinical trials been discussed by the treating team? *

How did you find the Clinical Trials Support Service? *

Please choose the option that best describes your ethnic group or background: *

Blood Cancer UK is committed to actively promoting equality, diversity and inclusivity. We are asking these questions because we want to make sure that we involve and support people from all backgrounds in our work.

If you would like to share any additional information about your diagnosis, medical history, previous treatment(s) you might have had please do so here. If your blood cancer or ethnic group is not listed please add it here.

For e.g. What is the plan from you medical team at present? How can the trial support service help? Anything further you'd like to share?

Please accept our terms of service *

We will store your personal information including any medical details you share with us. Your data is stored securely in line with the Data Protection Act 2018. Your personal information will not be shared with any third parties without your explicit consent. Whilst every effort is made to ensure that the most up-to-date information is provided to service users we can be limited by databases that are not frequently updated and are outside of our control. For further information please see our Privacy Policy. You have the right to request to be removed from our records at any time. You may periodically receive surveys intended to gather feedback on the service; participation is entirely optional.

Security check *

Once you 'Click to submit' below, you will be taken to a link where you can book a telephone appointment to speak to one of our nurses.

If you've selected email contact only, you will receive an email from a member of our trial support team within 1 working day.

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