If you have missed any of the required (*) information or neglected to check the last two statements your application will not go through. When you successfully complete the application you will receive an email soon after verifying we have received it. Within a few days you will receive another email letting you know if you application was approved. If you don’t have an email address, you may download the application, print a copy and mail it to HTI. Download and print an application by clicking HTI Application.

Human Touch Initiative
P.O. Box 3406
Rochester, NY 14623

About You
  •  I would like to receive email updates about HTI and its activities.
About Your Diagnosis



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Agreement
  • Without a small contribution from each participant our oncology massage program would not be possible. Please indicate a minimum amount of $10 up to a maximum of $35 you are able to contribute per massage (to be paid at the time of service). If contributing in this way is NOT possible please contact us to discuss further.

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  •  I understand and acknowledge that Human Touch Initiative, Inc. makes no representation or warranty with respect to any of the services I receive from its participating providers, and I agree to look solely to the individual provider in the event that I am dissatisfied in any way with the services I receive. *
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