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Sign Up to Receive Cards

Send Love Today provides emotional support and encouragement to brain tumor patients and their families throughout their difficult journey. We lighten their burden with a smile by sending homemade cards and small gifts filled with personalized messages of love, support and friendship.


Patient Questionnaire:

In order to send cards and gifts that are most appropriate, please provide the following patient information, which will be kept strictly confidential.


Send Love Today’s Patient Privacy Statement:

Send Love Today respects the privacy of all of our patients, and we will not give your personal information to anyone without your prior consent. By submitting this completed questionnaire to Send Love Today, you thereby give us your consent to provide only our volunteers with the information provided on this form, in order that they may send you personalized cards. At no time will they be given any medical information about you. If you prefer not to have your personal information given to our volunteers, we offer you the following options.


*(denotes required field)



Family Contact and/or Primary Care Giver:
(We will contact this person on a monthly basis for health updates on the patient.)


The Patient's Favorites:

Do you have any allergies (including but not limited to latex, peanuts, chocolate, eggs)? If so, please list below?




Send Love Today’s website includes a monthly Profile in Courage. If you would like to be highlighted one month, please check “yes” below and we will contact you for more information.



Consent

by clicking here, you, the patient or the parent of a minor child, give Send Love Today your consent to give their volunteers only my personal information as listed as my preference above on this questionnaire.


Please indicate your agreement to the terms above:

You may withdraw from Send Love Today’s program or change any of the information given in this questionnaire by calling (800) 716-7703 or by sending an email tolinda@sendlovetoday.org