Becoming a patient

Fill out our easy to use form below to get a call back from your local Icon Cancer Centre to discuss your treatment.

Treatment at Icon does require a referral from your GP or specialist, but we can help you understand the process and what to do next.

Are you enquiring for yourself or on behalf of another person?
- Myself
- On behalf of another person
Your postcode*
Patient's postcode*
Patient's full name*
Patient's email*
Patient's phone*
Your name*
Your email*
Your phone*
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Are you currently living in Australia?
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Nearest Centre
Has a doctor sent or is planning to send a referral to an Icon Cancer Centre?*
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What treatment are you looking for?
Condition*
How can we help?*
Terms*
- I acknowledge I have read and understood the Group Privacy Policy and agree to the collection, use and handling of my Personal Data in accordance with the policy.
Email
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Name*
Email*
Phone*
Your Centre
Message*
*
- I acknowledge I have read and understood the Group Privacy Policy and agree to the collection, use and handling of my Personal Data in accordance with the policy