You Can Stay - Accommodation Support for Youth Cancer Patients

New Patient Referral Form



Address Details:

New diagnosis
On Treatment
Check up/tests
Combination (in and out)
Yes - Aboriginal
Yes - Torres Strait Islander
Yes - Both Aboriginal and Torres Strait Islander

Treating hospital details

Supporting Information

- The young person's or family's background and current circumstance

- The financial impact of the cancer experience & how this is beyond their current capacity to manage financially


1 Bedroom
2 Bedroom
Not sure
a couple of weeks
at least one month
likely more than 3 months
likely more than 6 months
repeat bookings every month
Patient + Escort
Patient + Escort + Family

Some properties provide complimentary parking. If parking is essential and the patient/family are unable to cover their own parking costs,  please indicate this and Sony Foundation will also cover the cost.  Please note that if there is a need for long stay accommodation, we may request the patient/family stay at a Quest location with free parking.   


When a patient is accepted on to the You Can Stay program, we ask that they, and their referring clinician assist with completing some forms for Sony Foundation to secure a rebate from the government to offset some of the costs incurred to provide the accommodation. Please indicate below their eligibility, and note the extra detail required for VIC, QLD and TAS.

Yes, has applied/confirmed
Yes, has not applied / confirmed yet
No, not eligible
Not sure
Not sure

If a Patient is NOT ELIGIBLE:

A reason must be submitted at the time of referral for Sony Foundation to submit the stay under special considerations for funding approval. Considerations to include: family under financial difficulty, on a clinical trial, only just fall under the distance to qualify, etc.

If the patient is approved, the stay will only be granted for a maximum of 6 weeks, unless exceptional circumstances. During this time alternative accommodation needs to be arranged.

Yes - I, the referrer, consent to Sony Foundation collecting sensitive information about me.  I also represent and warrant that the patient has consented to Sony Foundation collecting sensitive information about them.

Thank you for completing the referral form.

Please make sure to click the SUBMIT button below.

If your form has been successfully submitted online, you will receive a confirmation email.

If you do not receive a confirmation email, please try again or email the patient details to 

Sony Foundation will advise if the patient meets eligibility criteria.

Quest will then contact the primary contact to coordinate the accommodation in the next 24 - 48 hrs.

If you have any questions, please contact; 

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