ChemoHero Box of Kindness Request Form

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Requesting a Box of Kindness
Please read

You can request a ChemoHero Box of Kindness if you are about to start cancer treatment, or if you have a loved one who is having treatment.

If you are receiving treatment in the Seamoor Unit at North Devon District Hospital, you will automatically receive a box at the start of your treatment.

If you are not being treated at the Seamoor Unit, please read the criteria below before completing the form to check that your request meets our guidelines.

Requests must be for:

• People receiving systemic cancer treatment such as chemotherapy, immunotherapy, targeted therapy or hormonal therapy

• People living in North Devon but having treatment outside of the area

• Patients receiving chemotherapy at home in the North Devon area

• Patients outside of North Devon (please note we can only send a limited number of boxes across the UK each month)

• UK residents only, as postage costs prevent us from sending overseas

Our Boxes of Kindness are designed for people who are at the start of their treatment cycle, not for those who have already completed treatment.

Postage information

Each box weighs just over 4kg and costs £7.05 to post using Royal Mail Tracked 48.

We only ask that you cover this postage cost. Payment will be collected once the form is complete.

Each Box of Kindness contains around £190 worth of useful and comforting items. While postage might seem a lot, what you’ll receive is something very special.

Thank you for taking the time to read this before making your request.

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What is you name?* This field is required.

First Name

Last Name

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What is you email address?* This field is required.This so we can conform we have received your request.

example@example.com

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Are you requesting a Box of Kindness for yourself?* This field is required.

YESNO

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What is the name of the person you are requesting a box for?* This field is required.Please input first and last name for the postal address.

First Name

Last Name

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Are they or you over 16 years of age?* This field is required.Our boxes of kindness may not be suitable for younger children. If the person you are requesting a box for is under 16 years of age, please email us at info@chemohero.com

YESNO

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Are you/they currently receiving or about to start S.A.C.T* This field is required.S.A.C.T = Systemic Anti Cancer Treatment Our Boxes of Kindness are filled with items specifically designed to support individuals currently undergoing cancer treatment. If you are not currently receiving treatment, the contents may not be appropriate for your needs.

YESNO

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Where are you/they receiving treatment?* This field is required.

The Seamoor Unit at NDDH

Home

Other

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If outside of North Devon, where are you/they receiving their treatment?* This field is required.

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What Box of Kindness would you like us to send?* This field is required.The majority of the items are the same in each box there just variations on the socks, hats and neck warmers

Female

Male

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Where would you like us to send the Box of Kindness* This field is required.Please double check the address is correct.

Street Address

Street Address Line 2

Town/City

County

Post Code

Country

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Would you like to send the recipient a message?We add a letter to each box from ChemoHero and are happy to add a message from you.

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How did you hear about ChemoHero* This field is required.Was it through a friend or family member? do you live in North Devon? where you told about us by another charity? or maybe did you find us through an internet search? We would love to know.

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Paying for Postage

My Bag

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Box of Kindness PostageThis is the cost of postage for a ChemoHero Box of Kindness. Using Royal Mail 48 Tracked.
£7.05Edit
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First Name

Last Name