Refer a Teen, Remind Them They’re Not Alone

To submit a referral, you will need to provide the following: child and parent/legal guardian’s contact information, child’s date of birth and medical condition(s), as well as the treating medical professional's full name, phone number and hospital treatment facility. Unfortunately, we cannot accept a referral without this information.

Who is eligible?

  • Patients ages 12–19 currently      undergoing cancer treatment
  • Newly diagnosed teens
  • Teens receiving chemotherapy or radiation
  • Patients experiencing extended hospital stays

Family

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Medical Team

City, State

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Who can refer a child?

  • Qualified healthcare providers (e.g., physicians, nurse practitioners, physician assistants), along with nursing staff, social workers, or child life specialists
  • Parents or legal guardians
  • Family members who are well-informed about the child’s current medical condition

What's the Process?

 Step 1 – Complete the Kent’s Cause Care Box Referral Form

 Step 2 – Submit the referral via the Kent’s Cause website

 Step 3 – Kent’s Cause coordinates delivery to the hospital or patient’s home