Get the Breast Cancer Personal Health Manager

The American Cancer Society and Kohl’s are pleased to offer the Breast Cancer Personal Health Manager kit. The kit provides new breast cancer patients with a file case to keep track of notes, questions, medication, appointments, and insurance statements. It also provides information regarding breast cancer diagnosis and treatment. It is offered at no cost through the generous donation of Kohl’s.

Please complete this form to receive the Breast Cancer Personal Health Manager.

First Name *
Last Name *

Street Address *

Address Line 2

City *
Zip *
County *

By completing this form, you attest that you or someone you love lives in southeast Wisconsin (Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Sheboygan, Walworth, Washington or Waukesha County) and is interested in receiving materials from the American Cancer Society. If the mailing address isn't in one of these counties, the request will not be filled.

For inquiries outside of these counties, please visit www.cancer.org

By submitting this form, you consent to the American Cancer Society’s use and disclosure of the information about you (including protected health information) to provide you with American Cancer Society information and/or services. You have the right to revoke this consent in writing. To the extent applicable, this form complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and a detailed description of our HIPAA policy is available for your review upon your request.

The Breast Cancer Personal Health Manager helps patients when they need it!

“I liked the pockets to organize every bill and piece of information regarding all doctor appointments. Thank you.”

“I think this was a wonderful gift that I intend to continue using. It was very informative and answered all my questions. Thank you!”

“I am using mine to make a file for my daughter. I am BRCA1 positive and I want her to have all of my health records in case she has the gene.”

“Keeps everything at my fingertips – very easy to navigate.”

“Knowing more about breast cancer helped with my fear.”