Critical Assist Referral Form

Critical Assist aims to support clients who are undertaking treatment for cancer and experiencing financial hardship and are at risk of not participating in treatment. Eligible clients can receive financial assistance and/or referral to an appropriate internal and/or external service.

Eligibility is confirmed by a health professional following a thorough assessment of the client’s financial and social situation. Before completing the referral, please read the Critical Assist Guidelines and Frequently Asked Questions.

You will receive an email confirming your successful submission of a referral. If you do not receive this email, please check your form for errors and resubmit.

Please note, approval for assistance is not guaranteed and will be at the discretion of Cancer Council Queensland and subject to availability. Applications are treated as confidential.

Telstra Bill Assistance Program

We are an agent for the Telstra Bill Assistance Program (TBAP).  The TBAP is a national program offered to Telstra account holders who are experiencing financial hardship and having difficulty paying their phone bill.  Through Critical Assist, clients may be eligible to have a bill paid up to $500. If your client is a Telstra account holder, please consider requesting this type of assistance for your client. Please read the Guidelines for TBAP before referring your client.

Digital Gift Cards

We have introduced digital gift cards to Critical Assist. Those individuals approved for assistance for a food or fuel gift card will now receive their card by email. This will allow the client to access their gift card immediately. Once received, the client can save the card to use on their phone, or print out the card and carry it with them.

If the client does not have access to email, you can request a print-out of the card to be sent by registered post to you or your client (this will have a waiting period and require a signature on delivery).

If you have any questions regarding eligibility or accessing the digital cards, please email or phone 13 11 20.

This referral form must be completed by a health professional on behalf of the client.

Health Professional Cancer Network