Class Details
Class Type
Class Content
Speaker
Day
Date
Start Time
End Time
Region
Venue
Please fill in your details for all the fields marked * to enable your registration to be completed. You do not need to be referred to register for a class. If you need any help completing your registration please call 0800 865 432.
Contact Details
First Name
Last Name
Email
This will be used to send class details, so please make sure it is the Contact's email address
x
Mobile Phone
02XXXXXXXXX
Street No and Address
City
Region
Please select...
Ashburton
Auckland Central
Auckland North Shore
Auckland South
Auckland West
Balclutha
Blenheim
Central Otago
Christchurch
Dannevirke
Dunedin
Featherston
Gisborne
Hamilton
Hawera
Hawke's Bay
Invercargill
Kaikohe
Kaitaia
Kapiti Coast
Kerikeri
Mangawhai
Masterton/Wairarapa
Murchison
Nelson
New Plymouth
Northland
Oamaru
Paihia
Palmerston North
Queenstown
Rotorua
Taumarunui
Taupo
Tauranga
Te Anau
Thames
Timaru
Tokoroa
Turangi
Wellington
West Coast Greymouth
West Coast Westport
Whakatane
Whanganui
Whangarei
Postcode
How did you hear about Look Good Feel Better?
Please select...
Cancer Society
Charity
Dove House/Hospice
Facebook
Feel Better Month campaign
Former Patient
Friend or relative
Hairdresser or Stylist
Health Professional - Doctor
Health Professional - Nurse
Health Professional - Social Worker
Insurance Provider
LGFB Volunteer
Media
Other
Pharmacy
Previously Attended
Sweet Louise
Web Search
Website
Wig Specialist
Is this your
FIRST
time registering for a LGFB class?
Please select...
Yes - its my first LGFB class
No - I have registered for a LGFB class before
Registration Details
Date of Birth
dd/mm/yyyy
Gender
Please select...
Female
Male
Gender diverse
Prefer to not say
Ethnicity
Please select...
European
Maori
Pacifica
Asian
Other
Middle Eastern
Latin American
African
Prefer to not say
What type of cancer are you being treated for?
Please select...
Bladder and Kidney
Blood
Bone
Bowel
Brain
Breast
Colon and Rectal
Gynaecological
Head and Neck
Liver
Lung
Lymphoma
Ovarian
Pancreatic
Prostate
Skin
Stomach
Testicular
Other
We like to thank the wonderful people who share our services. If you know the details of this person, please complete below. It is not a problem if you don’t know, or were not referred – please leave blank.
Referrer/Health Professional Name
Referrer/Health Professional Email
If email is not unknown, leave blank
Community Registration
Any special requirements eg wheelchair access?
Would you like to bring a Support Person?
Please select...
Yes
No
Support Person Name & Contact Details (Mobile/Email)
Pack Registration Details
The following information assists us in providing the best products to suit you in your kit of donated skincare and makeup. Please complete all categories
Please be aware that cosmetic, make-up and skincare products are provided and used at Look Good Feel Better classes. Look Good Feel Better is non-medical and those wishing to attend a Look Good Feel Better class should consult their oncologist if they have any concerns regarding the products we use. A list of the brands donated is available on our website. Please read our Privacy Policy for more information on how we use your information.
Are there any products/brands that you should not use for health or medical reasons (including reasons related to your treatment)?
Preferred Eyeshadow Shade
Please select...
Warm (Browns, Greens, Naturals)
Cool (Blues, Greys, Plums)
Preferred Lipstick Shade
Please select...
Warm (Corals, Naturals, Browns)
Cool (Pinks, Plums, Reds)
Skin Tone
Please select...
Very fair/Pink
Fair
Sallow/Golden
Medium
Olive
Dark/Mocha
Dark
Eyebrow Colour
Please select...
Blonde/Ash
Light Brown
Medium Brown
Dark Brown
Grey
Black
White
As you have registered previously online we have your information. Please proceed to submitting your registration.
Thank you for taking the time to provide us with information that will help us ensure you get the most out of your Look Good Feel Better experience.
If you have any questions please call 0800 865 432