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    • Prevention and awareness
      • What is Breast Cancer?
      • Breast cancer risk factors
      • Male Breast Cancer
      • Breast Cancer in 2SLGBTQIA+ People
      • Breast Cancer in Black Communities
      • Breast cancer prevention
      • Signs and symptoms of breast cancer
    • Screening and diagnosis
      • Breast cancer screening
      • Breast cancer examinations and diagnosis
      • Mammography
    • After the diagnosis
      • Breast cancer types
      • Treatment for breast cancer
      • Consequences and side effects of the disease
      • Metastatic breast cancer
    • After the treatments
      • Life after treatments
      • Pregnancy after treatments
  • Support me
    • Healthy lifestyle habits
      • My Active Health Nutrition
      • My Active HealthMC Physical Activity
      • Well-being
    • Support services
      • Service Eligibility Form
      • Financial support
      • Peer support
      • Psychosocial support
      • Medical support
      • Metastatic Breast Cancer Program
      • Genetic Counseling
    • Other services
      • Educational event
      • Educational materials
      • Resource Directory
  • Get involved
    • Involvement
      • Individualized breast cancer screening program
      • Become partner
      • Organize a fundraising
      • Make a donation
      • Organize a conference or an information booth
      • Buy pink
    • Actors in cancerology
      • Pink Compass Award
      • Financed projects
      • Awards and recognition
      • Calls for projects
    • Partnership
      • Our Buy Pink partners
      • Our other partners
    • Our Events
      • Breast Health Forum 2026 – Quebec
      • Clients
  • About
    • The Foundation
      • Mission, values and vision
      • Board of directors
      • Our team
      • Our Spokeswomen
    • Join us
      • Career Opportunities
      • Why choose us?
      • Contact us
    • Impact
      • Key statistics
      • Testimonials
  • Blog
  • Shop
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  • Contact us
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  1. Home
  2. Support me
  3. Support services
  4. Service Eligibility Form

Service Eligibility Form

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Do you have a breast cancer diagnosis?
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SECTION DIAGNOSTIC CANCER DU SEIN – NON

Are you supporting or providing care for someone who has breast cancer?
Are you a carrier of a genetic mutation that may increase the risk of breast cancer (for example, BRCA1 or BRCA2)?

Unfortunately, you are not eligible for our services as they are intended for people living with breast cancer and their caregivers.

If you have questions or concerns about breast cancer and need someone to talk to, our Peer support Helpline is there for you. This free and fully confidential helpline is available throughout Quebec. Our trained and experienced Peer Support Workers are ready to listen, answer your questions, guide you navigate the healthcare system, and connect you with the best resources for your situation.

Call us at 1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

We invite you to explore the activities offered by Maison Rose, a warm and welcoming place that provides a variety of activities and services. In particular, you can participate in virtual or in-person lectures, which are open to everyone. Check our program here.

We invite you to consult the “Inform Me“ section of our website to learn more about breast cancer, its risk factors, treatments, and much more!

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

As a carrier of a genetic mutation associated with an increased risk of breast cancer, you have access to the following services:

Our Peer Support Helpline offers a free and entirely confidential service across Quebec. Our trained and experienced peer pupport workers are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation.

1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

The Genetic Counselling Service is accessible to accompany you in your understanding of genetic factors related to breast cancer. This service evaluates the personal and/or familial history of breast cancer and helps you make informed decisions for your health and that of your relatives.

Learn more

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

Do you live in Quebec?
Do you live in Quebec?

Unfortunately, you are not eligible for our services as they are only available for people residing in Quebec.

We invite you to visit the « Inform me» section of our website to find out more about breast cancer, its risk factors, treatments, and much more!

We invite you to explore the activities offered by Maison Rose, a warm and welcoming place that provides a variety of activities and services. In particular, you can participate in virtual or in-person conferences, which are open to everyone. Maison Rose.

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person conferences, themed workshops (e.g., nutrition), oncology-focused beauty treatments, and discussion groups offered both online and in person. Discover our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

As a loved one of someone with breast cancer, you have access to the following services:

Our Peer Support Helpline offers a free and entirely confidential service across Quebec. Our trained and experienced peer pupport workers are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation.

1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

Access a free and confidential service offered by a specialized social worker. This service aims to accompany you with emotional, relational and practical challenges related to you or to the person being a caregiver. Whether you may need to better understand the illness, express what you are living or preserve your balance, we are here for you.

Learn more

The Genetic Counselling Service is accessible to accompany you in your understanding of genetic factors related to breast cancer. This service evaluates the personal and/or familial history of breast cancer and helps you make informed decisions for your health and that of your relatives.

Learn more

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

Please check the services you wish to register for:
Please check the services you wish to register for:

Other services, offered without registration

  • Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.
  • Pink line – Peer Support Helpline:

    Our helpline is a free and fully confidential service across Quebec. Our trained and experienced peer support worker are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation. Click here to know more.

    1-855-561-PINK (7465)
    Monday to Friday, 9:00 AM to 5:00 PM

Do you wish to submit a request?
Do you wish to submit a request?

You seem to be eligible to our Financial Assistance Service, but have chosen not to submit a request for the moment.

In the meantime, we invite you to visit the Inform Me section of our website to learn more about breast cancer, its risk factors, treatments, and much more!

This field is hidden when viewing the form

SECTION DIAGNOSTIC CANCER DU SEIN – OUI

Do you live in Quebec?

Unfortunately, you are not eligible for our services as they are only available for people residing in Quebec.

We invite you to consult the “Inform Me“ section of our website to learn more about breast cancer, its risk factors, treatments, and much more!

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Découvrez notre programmation ici.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

I would like to
This field is hidden when viewing the form

Verify my eligibility for the Foundation’s services

What stage was your breast cancer at the time of your most recent diagnosis?
At the time of your most recent diagnosis, what was your breast cancer stage?
Please enter the date according to your best estimates.
This field is hidden when viewing the form

In order to confirm your eligibility for our services, we would need to know the stage of your breast cancer. This information will enable us to better guide you toward the resources best suited to your situation.

In the meantime, you can now take advantage of our support services, including:

Our Peer Support Helpline offers a free and entirely confidential service across Quebec. Our trained and experienced peer pupport workers are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation.

1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

Access a free and confidential service offered by a specialized social worker. This service aims to accompany you with emotional, relational and practical challenges related to you or to the person being a caregiver. Whether you may need to better understand the illness, express what you are living or preserve your balance, we are here for you.

Learn more

The Genetic Counselling Service is accessible to accompany you in your understanding of genetic factors related to breast cancer. This service evaluates the personal and/or familial history of breast cancer and helps you make informed decisions for your health and that of your relatives.

Learn more

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

Please feel free to write or call us—we are here to support you, with kindness and confidentiality.

Phone : 514 871-1717
Toll Free : 1 877 990-7171

info@rubanrose.org

Please check the services you wish to register for:

Other services, offered without registration

  • Maison Rose – A Place for Rest and Learning:

    Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.
  • Pink line – Peer Support Helpline:

    Our helpline is a free and fully confidential service across Quebec. Our trained and experienced peer support worker are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation. Click here to know more.

    1-855-561-PINK (7465)
    Monday to Friday, 9:00 AM to 5:00 PM

You are eligible for the following services:

Our Peer Support Helpline offers a free and entirely confidential service across Quebec. Our trained and experienced peer pupport workers are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation.

1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

Access a free and confidential service offered by a specialized social worker. This service aims to accompany you with emotional, relational and practical challenges related to you or to the person being a caregiver. Whether you may need to better understand the illness, express what you are living or preserve your balance, we are here for you.

Learn more

The Genetic Counselling Service is accessible to accompany you in your understanding of genetic factors related to breast cancer. This service evaluates the personal and/or familial history of breast cancer and helps you make informed decisions for your health and that of your relatives.

Learn more

Supervised and safe oncology yoga classes, offered in studio or virtually, specially adapted for people affected by breast cancer. Led by trained and certified instructors.

Learn more

A soft and guided approach combining breathing, relaxation and full consciousness, conceived to improve physical and emotional wellness. Recognized as support care in oncology, it favours serenity.

Learn more

Accessible 24/7, this platform allows you to consult doctors, nurses and other healthcare professionals for free, in a few clicks, from you phone, tablet or computer.

Learn more

A personalized service for people with breast cancer, offering scalp care, manicures and pedicures. These services aim to relieve the effects of treatments, take care of the body, and support self-image in a caring and safe environment.

Learn more

A specialized massage therapy service offered to people affected by cancer, designed to provide relaxation, comfort, and well-being. Provided by students in the massage oncology program under professional supervision, these safe and personalized treatments take into account the specific needs related to the disease and its treatments, in a caring and respectful environment. Service available only at Maison Rose (Montreal)

Learn more

Virtual discussion group guided by a social worker, offered twice a month, destined for people living with metastatic breast cancer. This moment of exchange between peers offers a chance to share personal experiences with others who understand the reality of the illness.

Learn more

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

Please feel free to write or call us—we are here to support you, with kindness and confidentiality.

Phone : 514 871-1717
Toll Free : 1 877 990-7171

info@rubanrose.org

Please check the services you wish to register for:

Other services, offered without registration

  • Maison Rose – A Place for Rest and Learning:

    Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.
  • Pink line – Peer Support Helpline:

    Our helpline is a free and fully confidential service across Quebec. Our trained and experienced peer support worker are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation. Click here to know more.

    1-855-561-PINK (7465)
    Monday to Friday, 9:00 AM to 5:00 PM

This field is hidden when viewing the form
Please enter your zip code

You are eligible for the following services:

Our Peer Support Helpline offers a free and entirely confidential service across Quebec. Our trained and experienced peer pupport workers are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation.

1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

Access a free and confidential service offered by a specialized social worker. This service aims to accompany you with emotional, relational and practical challenges related to you or to the person being a caregiver. Whether you may need to better understand the illness, express what you are living or preserve your balance, we are here for you.

Learn more

The Genetic Counselling Service is accessible to accompany you in your understanding of genetic factors related to breast cancer. This service evaluates the personal and/or familial history of breast cancer and helps you make informed decisions for your health and that of your relatives.

Learn more

Supervised and safe oncology yoga classes, offered in studio or virtually, specially adapted for people affected by breast cancer. Led by trained and certified instructors.

Learn more

A soft and guided approach combining breathing, relaxation and full consciousness, conceived to improve physical and emotional wellness. Recognized as support care in oncology, it favours serenity.

Learn more

A deep relaxation and guided visualization method aiming to appease anxiety, support emotional adaptation and reinforce the feeling of interior calm. Offered in a caring and personalized framework.

Learn more

A personalized service for people with breast cancer, offering scalp care, manicures and pedicures. These services aim to relieve the effects of treatments, take care of the body, and support self-image in a caring and safe environment.

Learn more

Accessible 24/7, this platform allows you to consult doctors, nurses and other healthcare professionals for free, in a few clicks, from a phone, tablet or computer.

Learn more

A specialized massage therapy service offered to people affected by cancer, designed to provide relaxation, comfort, and well-being. Provided by students in the massage oncology program under professional supervision, these safe and personalized treatments take into account the specific needs related to the disease and its treatments, in a caring and respectful environment. Service available only at Maison Rose (Montreal)

Learn more

An online group animated by a social worker to accompany those having finished their active treatments and planning to return to work. In small groups, over the course of 7 weeks, to exchange, prepare yourself and find the best professional balance.

Learn more

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

Please feel free to write or call us—we are here to support you, with kindness and confidentiality.

Phone : 514 871-1717
Toll Free : 1 877 990-7171

info@rubanrose.org

Please check the services you wish to register for:

Other services, offered without registration

  • Maison Rose – A Place for Rest and Learning:

    Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.
  • Pink line – Peer Support Helpline:

    Our helpline is a free and fully confidential service across Quebec. Our trained and experienced peer support worker are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation. Click here to know more.

    1-855-561-PINK (7465)
    Monday to Friday, 9:00 AM to 5:00 PM

You are eligible for the following services:

Our Peer Support Helpline offers a free and entirely confidential service across Quebec. Our trained and experienced peer pupport workers are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation.

1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

Access a free and confidential service offered by a specialized social worker. This service aims to accompany you with emotional, relational and practical challenges related to you or to the person being a caregiver. Whether you may need to better understand the illness, express what you are living or preserve your balance, we are here for you.

Learn more

The Genetic Counselling Service is accessible to accompany you in your understanding of genetic factors related to breast cancer. This service evaluates the personal and/or familial history of breast cancer and helps you make informed decisions for your health and that of your relatives.

Learn more

A deep relaxation and guided visualization method aiming to appease anxiety, support emotional adaptation and reinforce the feeling of interior calm. Offered in a caring and personalized framework.

Learn more

Accessible 24/7, this platform allows you to consult doctors, nurses and other healthcare professionals for free, in a few clicks, from you phone, tablet or computer.

Learn more

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

Please feel free to write or call us—we are here to support you, with kindness and confidentiality.

Phone : 514 871-1717
Toll Free : 1 877 990-7171

info@rubanrose.org

Please check the services you wish to register for:

Other services, offered without registration

  • Maison Rose – A Place for Rest and Learning:

    Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.
  • Pink line – Peer Support Helpline:

    Our helpline is a free and fully confidential service across Quebec. Our trained and experienced peer support worker are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation. Click here to know more.

    1-855-561-PINK (7465)
    Monday to Friday, 9:00 AM to 5:00 PM

You are eligible for the following services:

Our Peer Support Helpline offers a free and entirely confidential service across Quebec. Our trained and experienced peer pupport workers are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation.

1-855-561-PINK (7465)
Monday to Friday, 9:00 AM to 5:00 PM

Access a free and confidential service offered by a specialized social worker. This service aims to accompany you with emotional, relational and practical challenges related to you or to the person being a caregiver. Whether you may need to better understand the illness, express what you are living or preserve your balance, we are here for you.

Learn more

The Genetic Counselling Service is accessible to accompany you in your understanding of genetic factors related to breast cancer. This service evaluates the personal and/or familial history of breast cancer and helps you make informed decisions for your health and that of your relatives.

Learn more

A deep relaxation and guided visualization method aiming to appease anxiety, support emotional adaptation and reinforce the feeling of interior calm. Offered in a caring and personalized framework.

Learn more

Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.

Don’t forget to subscribe to our newsletter to stay informed of our upcoming activities!

Please feel free to write or call us—we are here to support you, with kindness and confidentiality.

Phone : 514 871-1717
Toll Free : 1 877 990-7171

info@rubanrose.org

Please check the services you wish to register for:

Other services, offered without registration

  • Maison Rose – A Place for Rest and Learning:

    Come discover Maison Rose, a warm and welcoming place offering a variety of activities and services. You can participate in virtual and in-person lectures, themed workshops (e.g., nutrition), oncology-specific beauty treatments, and discussion groups offered both online and at Maison Rose. Check our program here.
  • Pink line – Peer Support Helpline:

    Our helpline is a free and fully confidential service across Quebec. Our trained and experienced peer support worker are there to listen, answer your questions, help you navigate the healthcare system, and guide you towards the best resources for your situation. Click here to know more.

    1-855-561-PINK (7465)
    Monday to Friday, 9:00 AM to 5:00 PM

This field is hidden when viewing the form
Please enter your zip code
Do you wish to submit a request?
Do you wish to submit a request?
Do you wish to submit a request?
Do you wish to submit a request?
Do you wish to submit a request?

You appear to be eligible for the services listed above, but you have chosen not to submit an application at this time.

In the meantime, we invite you to learn more about the services we provide.

Fill out a financial assistance application
This field is hidden when viewing the form

Confirm my eligibility for financial assistance

What stage was your breast cancer at the time of your most recent diagnosis?
Please indicate the situation that best reflects your history and treatments for breast cancer

Unfortunately, according to our criterias, you do not seem to be eligible for our Financial Assistance Service. If your circumstances change, you may submit a new request.

We invite you to consult our other various services. You may be admissible to psychosocial support and other services that may help your situation. Click here to learn more about which services you have access to.

If you have questions or concerns about breast cancer and need someone to talk to, our Peer support Helpline is there for you. This free and fully confidential helpline is available throughout Quebec. Our trained and experienced Peer Support Workers are ready to listen, answer your questions, guide you navigate the healthcare system, and connect you with the best resources for your situation.

Call us at 1-855-561-PINK (7465)
Monday to Friday, from 9 AM to 5 PM

You live:
What is your employment status/main source of income?
Please enter a number from 0 to 100.
Are your estimated gross earnings for the current year less than?
Are your estimated gross earnings for the current year less than?

Unfortunately, according to our criterias, you do not seem to be eligible for our Financial Assistance Service. If your circumstances change, you may submit a new request.

We invite you to consult our other various services. You may be admissible to psychosocial support and other services that may help your situation. Click here to learn more about which services you have access to.

If you have questions or concerns about breast cancer and need someone to talk to, our Peer support Helpline is there for you. This free and fully confidential helpline is available throughout Quebec. Our trained and experienced Peer Support Workers are ready to listen, answer your questions, guide you navigate the healthcare system, and connect you with the best resources for your situation.

Call us at 1-855-561-PINK (7465)
Monday to Friday, from 9 AM to 5 PM

It seems like you are eligible to our Financial Assistance Sservice. To complete your request, you must have access to your Quebec Notice of Assessement. Other documents could also be required.

A medical attestation will have to be completed by your health professional (treating doctor, nurse, social worker, etc.). Please note that a minimal delay of 12 months must separate each accepted request.

Do you wish to submit a request?
How would you like to receive the financial assistance?

You seem to be eligible to our Financial Assistance Service, but have chosen not to submit a request for the moment.

We invite you to consult our various services to which you may have access to.

Start the form again
This field is hidden when viewing the form

Section finale

Address*

Here is the medical form to be completed by a healthcare professional.

Medical information document

Drop files here or
Max. file size: 64 MB.

    To complete your financial aid application, please upload the following documents:

    • Your latest tax assessment notice
    • If you have a spouse, please also attach their notice of assessment.
    • A sample check
    Drop files here or
    Max. file size: 64 MB.
      Drop files here or
      Max. file size: 64 MB.

        If you have any difficulties with the form or if you have any questions, please write to us at: aidefinanciere@rubanrose.org

        I acknowledge having obtained approval from my medical team to participate in these adapted services and commit to informing the responsible parties of any significant changes to my health condition.*
        I release the Quebec Breast Cancer Foundation (FCSQ) and the providers of these services from any liability for bodily, psychological harm, loss, or injury that I may suffer, directly or indirectly, during or as a result of my participation in FCSQ activities, except in cases of gross or intentional misconduct on their part, in accordance with the applicable provisions of the Civil Code of Quebec.*
        I consent to participate in the services offered by the Quebec Breast Cancer Foundation with full knowledge and understanding.*
        Law 25 notice*

        I certify that the above information is accurate and complete. The anonymized data will be used for statistical purposes. As a means of verification, I authorize the Quebec Breast Cancer Foundation to discuss my file with the members of my medical team. I understand that the Quebec Breast Cancer Foundation reserves the right to refuse any request for a reason it deems reasonable, that the amounts disbursed in the case of a financial assistance request must comply with the limits of the budget allocated annually for this program, and that the amounts granted and the eligibility criteria may change without notice. *

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        1 855 561-ROSE (7673)

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        1115, avenue Laurier West,
        Montreal (Quebec), H2V 2L3
        Phone : 514 871-1717
        Toll-free : 1 877 990-7171
        info@rubanrose.org

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