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, you can download and print an enrollment form, click here to download our enrollment form. 

Please keep in mind that funding is limited and awards are issued on a first come first serve basis to the extent that funding is available. Therefore, mailing or faxing a paper application may delay processing time and funds may no longer be available once your application is reviewed. If that happens, you will receive a letter in the mail.

Completed enrollment forms can be mailed or faxed directly to:

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

Fax: 212-601-9760