CURE Childhood Cancer
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General Contact Information

Address
CURE Childhood Cancer, 200 Ashford Center North,
Suite 250, Atlanta, GA 30338
Click here for directions

Phone
770-986-0035 or 800-443-CURE (2873)
Fax: 770-986-0038

Email [email protected]

Receive Our Newsletters

We would like to keep in touch with you periodically to share what is happening with CURE Childhood Cancer. Please click the button below to subscribe to our enewsletter.

If your child has been diagnosed with cancer, LCH, HLH, brain tumor, or aplastic anemia, please fill out the form below.

" * " indicates required fields

Patient's First Name *
Patient's Last Name *
MM slash DD slash YYYY
Patient's Ethnicity *

MM slash DD slash YYYY
Treatment Status *
MM slash DD slash YYYY
Parent/Guardian First Name *
Parent/Guardian Last Name *
State *
Would you like to add contact information for child's other parent/guardian?
Address (leave blank if same as parent 1)
Siblings of Patient
Name
M/F
Birthdate
Is your child currently receiving treatment? *
Has your child completed treatment?
MM slash DD slash YYYY
Has your child had their first Survivorship Clinic appointment?
Treating Hospital *

Did you receive a CURE Tote?
We'd like to follow your child's journey
Please let us know how you learned about this patient information form? *

This field is for validation purposes and should be left unchanged.
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