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New/Annual Visitor Information Form

New/Annual Visitor Information Form

Each year, Cancer Support Community Valley/Ventura/Santa Barbara (CSCVVSB) gathers information about every participant to help us better understand who comes to our programs. All personal information will be kept confidential. Since we are a non-profit organization that does not charge for our services, we rely solely on donations to underwrite our programs and we need to collect the following information annually to help us secure funding. The information provided to funders only includes demographic data of all participants with no identifying information. Your answers to these questions will, in no way, affect your ability to access all programs at CSCVVSB at no charge.
  • If you need help completing this form or have any questions, please contact us at programs@cancersupportvvsb.org.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Please complete the following about YOURSELF

  • Date Format: MM slash DD slash YYYY
  • The following information will ONLY be used for funding purposes with NO identifying information.

  • Contact Us:

    Cancer Support Community Valley/Ventura/Santa Barbara
    530 Hampshire Road
    Westlake Village, CA 91361

    Phone / Fax / Email
    Phone: 805-379-4777
    Toll Free: 888-557-3177
    Fax: 805-371-6231
    E-mail: info@cancersupportvvsb.org

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Home | Privacy Policy | Phone 805-379-4777
                                                                                                                                                                                                                                                                                             The Cancer Support Community Valley/Ventura/Santa Barbara provides professional programs of emotional support, education and hope for people affected by cancer at no charge so that no one faces cancer alone. We serve West San Fernando Valley and Santa Barbara and Ventura Counties. Our main office is in Westlake Village with a satellite in Winnetka and offsite programs in Sylmar, at Olive New UCLA Medical Center, and in Ventura, at Ventura County Medical Center. We are proud of our hospital partnerships with the Cancer Resource Center at Community Memorial Hospital in Ventura and at the Cancer Center at St John’s Regional Medical Center in Oxnard and St John’s Pleasant Valley in Camarillo.                                                                                                                                                                                                                                                                                              Our programs provide a full-range of support and education for adults and children with cancer, their loved ones, and caregivers. Programs are provided in English and Spanish and include in orientation, groups for cancer survivors, family groups, groups for people beyond the day-to-day fight, cancer specific groups such as brain tumors, gynecological cancer, breast cancer, prostate cancer, Leukemia/lymphoma and melanoma. We also offer Kids and Teen Circle for children and teens affected by cancer, bereavement groups, and a buddy program.                                                                                                                                                                                                                                                                                              We service over 40 Southern California cities including: Agoura Hills, Oxnard, Calabasas, Santa Barbara, Camarillo, Canoga Park, Simi Valley, Carpenteria, Sherman Oaks, Encino, Sylmar, Tarzana, Los Angeles, Thousand Oaks, Malibu, Valencia, Newbury Park, Oak Park, Van Nuys, Ventura, Newhall, Westlake Village, Winnetka, and Woodland Hills. CPI Solutions IT Consulting in Ventura, Los Angeles and San Bernadino
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