New Client Referral Form

All of Wellness Place's programs and support services are completely free to those facing cancer in Chelan, Douglas, Grant, and Okanogan Counties.

To ensure these are the people we are serving, a completed referral form is required for every new client. This form may be submitted by the person with cancer, their caregiver, or a care team member. Either complete and submit this online form here, or you can download and print the PDF form below.  

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It is our policy to follow-up with the care team and/or new client to confirm eligibility. A Wellness Place staff member or volunteer will follow-up within 2 business days (M-TH, 9am-2pm) to confirm and fulfill requests.

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Please note, we do not offer medical advice or make medical oncology referrals.

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For any questions or assistance with submitting a referral form, please Contact Us.