The quickest and most secure way to enroll a patient with the foundation is to use the online process or you can call and speak with a Co-Payment Specialist.  Our toll-free number is 866-552-6729.

However, if you prefer to download and print an enrollment form, click here to download our enrollment form.  Once completed, you can mail or fax the form directly to:

CancerCare® Co-Payment Assistance Foundation
275 Seventh Avenue, 22nd Floor
New York, NY 10001

Fax: 212-601-9760

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