The Patient Financial Aid Program provides $100 a year to help patients offset expenses. Receipts for expenses are not required. To apply, you must be a U.S. resident or U.S. military personnel stationed abroad and in active treatment or ongoing medical follow-up care for a blood cancer. Your prescribing healthcare provider must complete and sign the bottom portion of the application form.
2013-2014 Patient Aid Form
The program begins each July 1st and ends on the following June 30th. You must reapply every year after June 30th in order to receive assistance. For more information, call us at (612) 259-4600 or email Teri.Cannon@LLS.org.