Patient Intake Form

Thank you for your interest in participating in the PCSC Program. Please complete the form below and our Program Coordinator will be in touch with further details on how to register.

Our virtual education sessions are available for everyone to attend. However please note, at this time only BC/Yukon residents currently in their home province are able to take advantage of the PCSC Program’s one-on-one clinical services.

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How did you hear about the PCSC Program?

I’d like to receive email from the PCSC Program, which may include newsletters, program updates, and other notifications.

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The Prostate Cancer Supportive Care (PCSC) Program is committed to the protection of your personal information. Please view our Privacy Policy for more information.