New patients please complete this form & submit once all fields have been filled out.Your details will only be used by N.I.C.A.M. A copy of our data protection policy can be requested via email. Any queries please do not hesitate to contact us. Name Your Address Your Email Address Tel No. Your Diagnosis Oncologist Date of Diagnosis Current Treatment Lymphoedema Reflexology YesNo Hyperbaric Oxygen Therapy YesNo Repurposed Drugs Information YesNo Refused individual Funding Request YesNo Culloden Spa Treatment & Will you bring a carer? YesNo Travel For Treatment Costs YesNo Patient Support YesNo