APPLICATIONS ARE CLOSED UNTIL OCT 2024.
Our welfare grant is designed to provide support to as many people as possible. Please be aware that the grant amount has been revised to a maximum of
£100.00
as a one-off payment. If your patient is experiencing financial difficulties, they may find Macmillan's information and advice services on other grants and loans helpful:
Other grants and loans
.
This form must be completed by a member of your care team.
Healthcare Professional Contact Details
First Name
Last Name
Job Title
NHS Trust
Contact Telephone Number
Email
Please select here to state that you are a healthcare professional completing this form on behalf of a patient.
I confirm the above statement is true
Reason for Request
Patient Details
Patient Name
Patient Address
Patient's telephone number
Please state patient's email address, if known.
Date of Scan and/or Treatment(s)
Mode of Transport e.g. Plane, Train, Taxi
Anticipated Cost (Max £100.00 - one off payment)
Number of people travelling
Patient's bank details - Please note, without the patient's banking details we are unable to process the application.
Patient's Bank Name - TSB, Lloyds etc.
Sort Code
Account Number
Name as it appears on bank account
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Contact Information