Request Pamper Session

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Request Pamper Session

Apply for Pamper Session at Imagination

Your name:

Address:

Email:

Phone:

Treatment applying for

Qualifying Condition:

Date of Diagnosis: (To qualify for a pamper session you must be within 3 years of a cancer diagnosis)

You will be required to supply evidence of your diagnosis (e.g. copy of email/letter or text) Please tick this box to confirm you have evidence.

Any other information you'd like us to know about:

Date:

Thank you for applying for a Pamper Session. We will get back to you as soon as possible.

Kind regards,

WWAC

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Tel: 07514 534978

Email: wwac19@hotmail.com

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