Enter Your Details With MARSupport

Please Note: This form only records your details with MARSupport, it is not a contact form. As we are often on the road, or not in the office when we talk with those we support, providing your details to MARSupport, either before or after you phone the Asbestos Disease Helpline, is a great help to us – so thank you in advance. Please be assured your details are not passed onto any other individual or organisation without first receiving your permission to do so, on an individual needs basis (when making referrals on your behalf, etc.).

The MARSupport Asbestos Disease Helpline and other support services are only available to Australians who have been diagnosed with mesothelioma or another asbestos related disease, their carers, immediate family members and to those bereaved who have provided their details and also spoken with the Support Co-ordinator. If you haven’t already read all about MARSupport please [click here].

Your Name*

Your Email Address*

Your Phone Number*

Street Number and Name*

City*

Region (State or Territory)*

Postcode*

Country*

Are you a sufferer of an asbestos related disease, or a carer, immediate family member (daughter, son, etc.) or bereaved loved one of an asbestos related disease sufferer? (Please state which you are)*

What form of mesothelioma or other asbestos related disease have you been diagnosed with, or your loved one has been, or was diagnosed with?*

To help us to know your circumstances a little better, please include any information you feel may be relevant to why you will be phoning, or have phoned, the Asbestos Disease Helpline (e.g. when diagnosed, treating doctors, treatment, if registered with Dust Diseases Care, work history, legal representation, dates, etc.).

PLEASE NOTE: THIS FORM ONLY RECORDS YOUR DETAILS WITH MARSupport - IT IS NOT A CONTACT FORM AND IS NOT RESPONDED TO

*Required Field

Thank you for providing your details to MARSupport, it will help us immensely once you access the Asbestos Disease Helpline, or if you already have. Please Note: As stated earlier, this form only records your details with MARSupport, it is not a contact form. If you haven’t already done so, and wish to access the Asbestos Disease Helpline, please click on the Contact Information button below to find out what number to call, and the best time to call, depending on your circumstances.

Contact Information

If you, or a loved one has been diagnosed

with MESOTHELIOMA ASBESTOS CANCER or another ASBESTOS RELATED DISEASE and you would like to talk to somebody who knows what it feels like to be in similar circumstances to what you are in, whether you are a sufferer or carer, please phone the Foundation’s 24/7 Support Helpline.

Note: The Bernie Banton Foundation is not accredited to provide advice. The information and/or advice provided is for assistance only. The advice of a qualified specialist should always be sought before making legal or medical decisions.