Partner Portal
Welcome to Addressing Cancer Together’s Partner Portal.
This page is for partners and providers who are approved to refer patients to Addressing Cancer Together (ACT).
Please use the options below to refer patients or submit follow-up documentation. By using the links below, you can help us to better manage patient referrals and receive documents in a way that protects patient health information.
Referring a patient.
To refer a patient to ACT, please be sure you have this information ready to submit:
- Patient Consent in English or Patient Consent in Spanish
- Patient diagnostic records
- Patient financial information (pay stubs, bank statements, etc.). If the patient does not have income and needs to submit a letter of support from a friend or family member, use this form letter.
Submitting follow-up documentation.
At times, ACT will need additional documentation to help ACT patients. Follow-up documentation might include: Signed patient financial assistance forms, recent pay stubs, recent bank statements, or other proof of income and assets.
If you are helping a patient and need to submit additional documentation, please use the link below. You will need the Patient Full Name and Date of Birth.
You can use the provided link to submit any type of document to ACT to support patient care and access.
