If you are impacted by cancer or other chronic illness, either as a patient or caregiver, we would like to hear from you as to what types of help or support you could use. Please fill out our survey below or contact us to provide feedback.

You can learn more about the Elixir Fund Registry here, or for a complete list of the businesses that are participating so far, please click here. We are always open to suggestions on what businesses or services you would like to see included.

    What are some things that you have difficulty with as a result of treatment? check all that apply
    Self CareFood (grocery shopping, preparing food, or just getting a meal on the table)TransportationHousehold chores (housecleaning, landscaping)Pet CareOther (you can type your response in the box)

    What are some of the other things that you would like access to? check all that apply
    NutritionMassageIntegrative therapies (yoga, pilates, meditation)Family activities/time with friends (dinner out, going to the movies)Other (you can type your response in the box)

    Would you be willing to create a registry (like a bridal or gift registry) to receive gift certificates to help meet some of the needs you listed above?
    YesNo

    If yes, we would like to invite you to be part of a pilot project, the Elixir Fund Registry. The first 20 participants receive a free blanket.

    If you would like more information on this project and you can participate, please fill in your information below:

    Your Name (optional)

    Your Email

    Mailing Address (optional)

    What is your preferred method of contact?
    MailEmail

    Thank you for your time in answering these questions for us.