Financial Assistance Help

If you are an adult (18 or over) in the United States and have cancer treatment bills then please apply by using this form: Preliminary Donee Application (PDF)

  • This form has been updated for Q2 2020 (April).
    If you have submitted a form that doesn’t state “Revised March 2020” you will have to resubmit with the correct form.
  • Please fill out the form in its entirety and submit it to one of the addresses on the top-right of the form.
  • Currently our application windows are open in the months: January, April, July and October. If you apply in a month not on this list then we will carry over your application to the following application window.

If you have any further questions, please check out our Frequently Asked Questions (FAQ).
If your question is not listed in our FAQ please feel free to contact us.