Medical Professional Request for PIB(s) to go to their patient

Patient Information Booklets

Fight Bladder Cancer has produced a suite of Patient Information Booklets that are available to order for your patients. These are supplied free of charge.

**Please note: When you order the booklets for your patients, these will be of a smaller and more manageable size, slightly bigger than A5**

Please complete this form and they will be sent free of charge directly to your patients from the Fight Bladder Cancer office.

First Name

Last Name

Fight Bladder Cancer is committed to protecting and respecting your privacy. They will only collect the information they need as is necessary to provide their services. The information that will be passed to Fight Bladder Cancer will be used to supply the booklets requested and any data provided will be stored in line with their Privacy Policy, which can be viewed at fightbladdercancer.co.uk/privacy-policy.

Please check the box below to confirm that the patient has been made aware of this:

Yes, the patient has confirmed they are happy for me to share their details with Fight Bladder Cancer

First Name

Last Name

Thank you for completing this form, we will arrange for these materials to be sent to your patient as soon as possible. Please contact the Fight Bladder Cancer office on 01844 351621 if they haven't arrived within 7 working days.