Helping
Hands
A Service of Mary Bird Perkins Our Lady of the Lake
Patient Registration
First Name
Last Name
Username
Letters and numbers only.
Email Address
Create Password
At least 8 characters.
Confirm Password
Address
City
State
Zip
Primary Contact Phone Number
Other Phone Number
Preferred Method of Notification
Email
Text
Cell Phone Provider
AT&T
Boost Mobile
C-Spire
Consumer Cellular
Cricket
Google Fi (Project Fi)
Metro PCS
Page Plus
Republic Wireless
Sprint
T-Mobile
Ting
Tracfone
U.S. Cellular
Verizon
Virgin Mobile
About Me
I agree to hold the Mary Bird Perkins Cancer Center harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including attorney's fees, as a result of my participation in Helping Hands, including any events incidental to Helping Hands. CONSENT FOR RECEIVING INFORMATION: I consent to receive mailings, telephone or cell phone calls, and/or emails concerning surveys, appointments, screenings, services, events, fundraising or programs at or sponsored by Mary Bird Perkins Cancer Center.