Financial Assistance


Breast Cancer Solutions provides temporary financial assistance to eligible patients who are experiencing financial hardship as a result of their treatment. You may be eligible for financial assistance if you are currently in treatment for breast cancer, have financial need, and live in Orange County (CA).


  • We do not currently have funding for San Bernardino or Riverside Counites.
  • Submitting a completed application does NOT guarantee that you will receive financial assistance.
  • Please call 1-866-960-9222 if you have questions regarding financial assistance.

Online Financial Assistance Application Request

  • Click the link above to request an application by email or postal mail.
  • When you receive your application, fill out pages 1-4.
  • Fill out the top of page 5 (AUTHORIZATION), then give pages 5-6 to your physician to complete.
  • Submit your entire application to Breast Cancer Solutions by mail, fax, or scan/email to
  • Your application will not be processed until we have received all 6 pages.

Request application by mail
To request an application by mail, please call 866-960-9222.
Para recibir una solicitud por correo, llame 866-960-9222.

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

You are not eligible for financial assistance if you:

  • Have completed your surgery, chemotherapy and/or radiation; and/or
  • Have no evidence of disease (NED); and/or
  • Are taking a long-term hormonal treatment only (e.g., Tamoxifen) for stage I, II, or III cancer; and/or
  • Are receiving hospice/palliative care only; and/or
  • Are in the process of undergoing reconstruction but not receiving any other treatment; and/or
  • Stop treatment for any reason against your doctor’s advice; and/or
  • Have over $1,000 in liquid assets (does NOT include 401Ks, IRAs, vehicles or personal items)

Contact Us

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