This form was designed with the intent to ensure that all essential information is collected when The Leukaemia Foundation receives a request for transportation services or financial assistance towards transportation support. The Leukaemia Foundation has finite resources with which to provide support to people living with blood cancer to get to and from their treatments or medical appointments. This assessment process allows us to assess all requests and ensure that we match you with the best suitable option based on your individual circumstances and requirements. Please note that 3 working days notice is required, if your request is for transport assistance within that time frame, please contact us on 1800 620 420.  Please ensure that all fields are completed and should you have any further queries please contact us at financialassistance@leukaemia.org.au