If you are a cancer patient and would like to order a kit for yourself, please download the order form below* to qualify for a subsidized rate. Forms should be mailed or faxed to us, per instructions on the bottom of the form. We hope your Chemo Comfort kit will help ease the journey as you undergo treatment.


* This form is ONLY for cancer patients currently undergoing chemotherapy. Anyone else, including family members, should download the form on the “Send a Gift Kit” page. Orders not properly submitted will be returned. No exceptions will be made. NO THIRD PARTY PAYMENTS ARE ACCEPTED.

For this program, we only ship to the continental United States.


Please fill out this form.