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Immediate Assistance Program
 
FINANCIAL ASSISTANCE IS AVAILABLE
  Read carefully below before downloading application.
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Applicant Eligibility:
  • Currently in treatment for any type of cancer.
  • Living in Los Angeles County, Riverside County, San Bernardino County, Orange County or Texas.
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Type of Assistance:
  • Hospice
  • Gasoline
  • Groceries
  • Utility Bills
  • COBRA Assistance
  • Prescription Co-payment
  • Doctor Visit Co-payment (max $50 per visit)
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Please Note: our services are being provided out of Love & Kindness, so please demonstrate the same Love & Kindness to our staff. Therefore, we have the right to refuse service to anyone who disrespects our staff members.
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For additional assistance, please complete the form below.
First Name:
Last Name:
Email:
Phone:
City:
State:
Comments:
 
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