Glen Adnam Cancer Comfort Basket Foundation

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Request a Comfort Basket

Thank you for reaching out to the Glen Adnam Cancer Comfort Basket Foundation. We know that asking for help isn’t always easy. Whether you’re completing this form for yourself, a loved one, or a patient in your care, we’re honoured to be part of their journey. Every request is treated with compassion, respect, and confidentiality. Please complete the information below. If you’re unsure about a question, simply answer as best you can. We’ll contact you if we need any additional information.

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Thank you for your response. ✨

Section 1 — Requester Information

Who is completing this form?(required)
Preferred Method of Contact(required)

Section 2 — Before You Continue (Privacy Notice)

The information you provide helps us prepare a comfort basket that best supports the individual receiving it. Your personal information will only be used to process this request and will remain confidential.

Is the Recipient Aware That This Basket Is Being Requested?(required)
Does the Recipient Consent to Being Contacted by the Foundation?(required)

Section 3 — Basket Type

Which Type of Basket Are You Requesting?(required)

Section 4 — Cancer Journey Information

We only ask for information that helps us understand the recipient’s needs. Please share only what you are comfortable providing.

Current Stage of the Cancer Journey
Current or Upcoming Treatment (select all that apply)
Is the Recipient Currently in Hospital?

Section 5 — Comfort Basket Preferences

We do our best to personalize each basket based on available items, donated products, safety considerations and the information provided.

Hobbies or Interests (select all that apply)

Clothing or Comfort Item Size

Would the Recipient Appreciate Faith-Based or Spiritual Items?
Would the Recipient Appreciate a Handwritten Note or Card?

Section 6 — Allergies, Sensitivities and Safety Information

Does the Recipient Have Any Allergies?
Does the Recipient Have Any Food Allergies or Dietary Restrictions? (select all that apply)
Does the Recipient Have Any Skin Sensitivities?