PATIENT FINANCIALASSISTANCE INSTRUCTIONS PATIENT FINANCIAL ASSISTANCE REQUEST FORM

MCCA has a program to help provide limited financial assistance for cancer patients.  After completing requirements, each patient is allotted $2,000 for expenses such as rent, mortgage, utility bills, medical bills, etc., PLUS mileage to medical appointments.

Requirements:

• Minimum 1-year permanent residence in Montgomery County
• Written order by attending physician as proof of cancer diagnosis
• Completed MCCA application

Contact Daniel Britton at (217) 710-0301 for an application; or any board member for more information

Downloadable now available online! Please click on the links below. Download both the Instructions and Request Form.