Volunteer Resources

Application for Patient Assistance
Cover Letter

2020 Registration Form -fee will be waived until we are certain event is not cancelled (Download Here)

Application for Patient Assistance


I consent to the Release of Information concerning the undersigned patient in accordance with state and federal laws to Cancer Care of Marquette County, its Patient Care Director and the Patient Care Coordinators. I understand that once my health information is used or disclosed pursuant to this authorization, it may be subject to re-disclosure or release by the receiving party and may no longer be protected by Federal or State Law, unless protected by Federal Regulation 42CFR Part 2 and Public Act 258 to in which case it cannot be re-disclosed by the receiving party without my written authorization. I agree indemnify and hold harmless Cancer Care of Marquette County, their employees and agents free and harmless from any actions against them for alleged invasion of privacy, libel or slander, defamation arising from or related to disclosure of such information.