Friends Like Me Care Package Self-Request Form
Fields marked with an asterisk (*) are required.
Friends Like Me care packages have been carefully produced to address the needs of recipient diagnosed with breast cancer within the last six months. The materials are designed to support the new patient in a timely manner during those critical first few months when she is dealing with her diagnosis and making decisions about treatment options.
- Please review the eligibility requirements
- The Friends Like Me care package must be sent directly to the survivor.
- You may request a Friends Like Me™ care package for yourself.
- We customize each care package according to the specifics of the recipient’s situation.
- If you have been diagnosed with Metastatic or stage IV Breast Cancer, please select “yes” under Recipients Information to ensure you receive a Friends Like Me2 care package.