Integrative Oncology Partners

Integrative Oncology Partners
YASU is expanding it's support with an Integrative Oncology Partnership Program. In the past, integrative oncology services were included as one of the financial assistance grants; however, members will now have access to both services!

The process:
YASU members will be invited to apply for integrative oncology services. A YASU representative will send the referral to a partner who has completed this form. The Partner will then submit a monthly invoice to YASU for compensation.

As a partner, you agree to:
- Submit an updated W-9 to Stephanie Samolovitch, YASU founder & executive director (through Gusto, our payroll company, if you prefer ACH payments, or by emailing it to Stephanie if you prefer check payments)
- Provide integrative oncology services to registered YASU members (young adult cancer patient/survivor or caregiver/co-survivor)
- Invoice YASU with a detailed report of service provided, date of service, service fee, and individual it supported. Payments will be made on a monthly basis (details below in the form).
- If you are interested in becoming a partner, please see the following information and complete this interest form. Please direct any questions to Stephanie: stephanie@yasurvivors.org, 724-719-2273.
YASU gratefully acknowledges support from AstraZeneca!
Name

First NameLast Name
Company Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Oncology MassageAcupunctureYogaMeditationPersonal TrainingCryotherapyRed Light TherapySaunaCompression TherapyCounselingNutritionMedical Marijuana card registration and/or yearly state fee (if applicable)Other
If you selected "other", please list the service(s) not included in the list. Enter N/A if you did not select "other".
What is the fee for service(s) you provide? List each service and cost:
via phone callemaila form submission, provided by you/your companyonline link, provided by you/your company
Depending how you prefer to receive referrals, please list the phone number, email address, or URL that a YASU representative can utilize when making a referral:
ACH payment (an invitation to complete banking information and submit a W-9 will be emailed from Gusto, the Payroll company that YASU uses).Check (include who to make payment to, and the mailing address, on the invoice)
Emailed to stephanie@yasurvivors.orgMailed to YASU, 1000 Brooktree Rd, Suite 105, Wexford, PA 15090
YesNo
YesNo
Integrative Oncology Services Disclaimer

Young Adult Survivors United (YASU) is committed to supporting young adults impacted by cancer by connecting members with resources that promote well-being, healing, and resilience. As part of this commitment, YASU may refer members to integrative oncology services provided by independent third-party practitioners or organizations. These services may be made available to eligible YASU members at no cost to the participant through YASU programming or partnerships.

All integrative oncology services are provided solely by independent third-party providers who operate separately from Young Adult Survivors United. These providers are not employees, agents, or representatives of YASU, and YASU does not supervise, control, or direct the care or services they deliver.

By choosing to participate in any referred service, you acknowledge and agree that Young Adult Survivors United serves only as a referral and connection to these resources. YASU is not responsible or liable for the services provided, the quality of care, or any outcomes resulting from participation in services delivered by third-party providers.

Participation in any integrative oncology service is entirely voluntary, and participants are encouraged to consult with their oncology team or licensed healthcare provider before beginning any new therapy, treatment, or wellness service.
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