• Financial assistance is only available in Orange, Riverside and San Bernardino Counties (California).
  • Your current annual household income must be at or below 300% Federal Poverty Level (click for chart with details)
  • Please call 1-866-960-9222 if you have questions.
  • Submitting an application does NOT guarantee that you will receive financial assistance.

You are NOT eligible for financial assistance if you:

  • Live outside of Orange, Riverside, or San Bernardino County (California)
  • Have completed your surgery, chemotherapy and/or radiation
  • Have no evidence of disease
  • Are taking a long-term hormonal treatment only (e.g., Tamoxifen) for stage I, II, or III cancer
  • Are receiving hospice/palliative care only
  • Are in the process of undergoing reconstruction but not receiving any other treatment
  • Stop treatment for any reason against your doctor’s advice
  • Have over $6,000 in liquid assets (does NOT include 401Ks, IRAs, vehicles or personal items)

Download the Application in English
Download the Aplicacion en Espanol/Application in Spanish
Download the ĐƠN XIN HỖ TRỢ TÀI CHÍNH/Application in Vietnamese

    Financial Assistance Application Request Form

    Please send me a financial assistance application by:

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    Contact Us

    Call us at 866.960.9222 or click HERE to use our convenient contact form.