Financial Asistance | Lovie Helping Hand Cancer Foundation

Patient Financial Assistance Application

Because no one should fight cancer alone.

Eligibility Requirement

Applicants must be actively undergoing treatment (chemotherapy, radiation, surgery, or immunotherapy) or within six (6) months post-treatment.

How We Provide Assistance

At Lovie Helping Hand Cancer Foundation, our goal is to deliver support with integrity, compassion, and accountability. To ensure that every dollar directly benefits those in need, we do not issue cash or personal reimbursements. All approved assistance is provided through direct vendor payments or controlled-use gift cards.

1. Medical Co-Pays & Prescriptions (Up to $250)

We assist with the cost of cancer-related prescriptions and medical co-pays through:

Direct payments to pharmacies or providers (if accepted)
Store-specific pharmacy gift cards (e.g., Walgreens, CVS, Walmart)
No reimbursement for previously paid prescriptions or appointments

What we need from you:

Recent invoices, pharmacy receipts, or statements from a healthcare provider or facility OR a written explanation of need.
Proof of reduced income or inability to work
A referral or note from a caseworker, social worker, or physician documenting the financial burden
Authorization to contact them, if needed

2. Groceries & Household Essentials (Up to $150)

We provide support for urgent food and essential home needs (cleaning supplies, toiletries, etc.) via:

E-gift cards or store-specific gift cards (Walmart, Target, H-E-B, etc.)
Gift cards sent electronically or by mail
No back payment for previously purchased items

What we need from you:

A written explanation of current grocery or household need
Proof of financial hardship, such as:
Income loss
SNAP/WIC enrollment
Current participation in SNAP/WIC or a referral from a food pantry, church, or clinic
Your preferred grocery store

3. Rent, Mortgage, and Utility Bills

We understand that cancer can put families at risk of losing their homes or essential services. We assist by making direct payments to landlords or utility companies.

We may cover bills such as:

Rent or mortgage (partial or one-time support)
Electricity, water or gas,

What we need from you:

Copies of overdue rent, utility bills, eviction notices, or shut-off warnings
Contact information for the landlord, leasing office, or utility company
Your account number and name on file

Important Notes:

We do not provide cash, checks to individuals, or open-ended debit cards
All financial support is tracked and documented internally for transparency
Recipients may be asked to verify receipt and confirm the intended use of the assistance

Fill out the form

PERSONAL INFORMATION

First name

Last name

Birthday

Month

Day

Year

Phone

Address

DIAGNOSIS INFORMATION

Type of Cancer Diagnosed

Date of Diagnosis

Month

Day

Year

Treatment Facility / Hospital

Are you currently in active treatment?

Yes

Name of Oncologist or Primary Doctor

ASSISTANCE REQUESTED

All applicants must provide documentation showing the specific financial need related to these categories.

Check all that apply

Amount needed

Explain your current financial hardship:

Proof of Financial hardship (required documents are listed at the top of the page)

1. Letter from your treating physician or healthcare provider

2. A personal written statement

3. Proof of Financial Hardship (see requiered documents at the top of the page)

I confirm the information provided is accurate to the best of my knowledge. I understand that completing this application does not guarantee financial assistance.