AHN Cancer Institute Second Opinion Request Form

If you have advanced-stage, rare, or complex cancer, you have all of our cancer experts to review your medical records and offer a second opinion. You can use our remote consultation option to discuss treatment options with our cancer expert from anywhere.

To get started, complete this form and click the submit button. Then we’ll get back in touch with you.

Tell us about yourself

Contact information

Full Name

City

E-mail Address

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Medical history

Type of cancer

Current care provider or doctor

Medical records

I have access to and can share my medical records for any of the following: Pathology report from initial diagnosis, Operative report, Medical oncology visit note (most recent), CT Scan/MRI Scan/PET Scan reports (most recent 2), Recent labs/Tumor markers. (All labs from the past 30 days ONLY).

If patient is a breast cancer patient, we will need breast imaging past three years to include mammography, ultrasound and breast MRI.

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Additional information

Briefly explain your expectations or goal(s). 0 / 5000

How did you hear about AHN Cancer Institute? 0 / 5000

Make sure you know when we’re contacting you:

Add cancersupport@ahn.org to your email’s safe senders list.
Add (412) 359-3595 to your phone’s contact list as “AHN Cancer Institute.” But don’t call this phone number — we only use it for outbound calls. We’ll let you know how to contact us directly during your initial consultation.

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