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Mustard Tree: Macmillan Benefits Advice Appointment Request

Please note that this is simply a request for an appointment with the Macmillan Benefits Advisor. Your request will then be triaged and a member of staff will then contact you to arrange an appointment, if suitable. It would be useful if you could have ready, details of your current income and any benefits in payment.

Please do not enter any healthcare information on this form.

Macmillan benefits advice

Note: Questions marked by * are mandatory

*This is a mandatory field. First name:

*This is a mandatory field. Surname:

*This is a mandatory field. Date of birth:

*This is a mandatory field. Contact number (including area code):

*This is a mandatory field. Email address:

*This is a mandatory field. I consent for a message to be left

not at all
on answerphone
with a member of the household

*This is a mandatory field. I would like help with: (tick all that apply)

Blue badge application
General benefits/financial advice
help with completing PIP/AA forms
Macmillian Grant
Travel costs - to and from the hospital

*This is a mandatory field. I confirm that I am a patient of University Hospitals Plymouth and am receiving treatment for a cancer diagnosis

Yes
No

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