• Financial Assistance Policies & Guidelines

    Eligibility Criteria

    Applicants must:
    • live in or receive treatment in our four-county service area (Benton, Madison, Carroll, Washington).
    • have a confirmed cancer diagnosis; proof of diagnosis is required.
    • demonstrate financial need related to a cancer diagnosis.

    The following requests for assistance will be considered:

    Short-Term Living Expenses
    To be eligible for financial assistance for living expenses, applicants must be in active treatment or within one year of treatment completion. Active treatment is defined as chemotherapy (IV or oral), immunotherapy, radiation therapy, bone marrow or stem cell transplant, and/or surgery.
    Examples of living expenses: rent, mortgage, utilities, homeowner’s insurance, car payment, and/or car insurance.

    Travel & Lodging Costs
    Travel needs, such as hotel and air fare, for out of town consultations or treatment.

    Supplemental Fuel Costs
    Prepaid gas cards are provided to patients for travel to cancer-related appointments. Fuel costs are calculated based on vehicle type and mileage. Fuel is supplemental, we do not typically cover the full cost of a trip.

    Medication
    Need for medication must be directly related to the cancer diagnosis. Payment is made directly to a pharmacy.

    Dental Care
    Need for dental care must be directly related to cancer treatment. Confirmation from an oncology health care provider is required.

    Transportation
    Rides to cancer-related appointments and treatment. Must live in our four-county service area or no further than 60 miles one-way from appointment location.

    Emotional Support
    Individual, couples, caregivers, and/or family members may access mental health counseling services to address cancer-related concerns.

    *It is our goal to provide a response to assistance requests in a timely manner. Please allow one business day for medication requests and up to 7 business days for other financial assistance requests.

    The mission of Hope Cancer Resources is to provide compassionate, professional cancer support and education in the Northwest Arkansas region today and tomorrow.

    Our Financial Assistance Program is supported in part through partnerships with the  Cancer Challenge, Delta Dental, Northwest Medical Auxiliary, Hope Cancer Resources Foundation, as well as corporate and individual donors

  • Application for Assistance



  • If Other, please specify:

  •  - -
    Pick a Date
  •  - -
    Pick a Date

  • Vehicle Information:
                 

  • function SvgDhtupload2(props) { return /* @__PURE__ */ react.createElement("svg", dhtupload_svg_extends({ width: 54, height: 47, xmlns: "http://www.w3.org/2000/svg" }, props), dhtupload_svg_path || (dhtupload_svg_path = /* @__PURE__ */ react.createElement("path", { d: "M40.213 10.172c1.897.21 3.68.738 5.35 1.58a15.748 15.748 0 0 1 4.374 3.242 15.065 15.065 0 0 1 2.951 4.533c.72 1.704 1.08 3.522 1.08 5.455 0 1.827-.28 3.654-.843 5.48-.562 1.828-1.379 3.47-2.45 4.929A13.39 13.39 0 0 1 46.669 39c-1.599.948-3.452 1.458-5.56 1.528H37.26a1.62 1.62 0 0 1-1.185-.5 1.62 1.62 0 0 1-.501-1.186c0-.457.167-.852.5-1.186.334-.334.73-.5 1.186-.5h3.848c1.44 0 2.75-.37 3.926-1.108a10.851 10.851 0 0 0 3.03-2.846 13.53 13.53 0 0 0 1.95-3.9 14.23 14.23 0 0 0 .686-4.321c0-1.582-.316-3.066-.949-4.454a11.623 11.623 0 0 0-2.582-3.636 12.857 12.857 0 0 0-3.742-2.478 11.054 11.054 0 0 0-4.48-.922l-1.212-.053-.37-1.159c-.878-2.81-2.292-4.998-4.242-6.562-1.95-1.563-4.594-2.345-7.932-2.345-2.108 0-4.005.36-5.692 1.08-1.686.72-3.136 1.722-4.348 3.005-1.212 1.282-2.143 2.81-2.793 4.585-.65 1.774-.975 3.68-.975 5.718h.053l.105 1.581-1.528.264c-1.863.316-3.444 1.317-4.744 3.004-1.3 1.686-1.95 3.584-1.95 5.692 0 2.39.8 4.462 2.398 6.219 1.599 1.757 3.488 2.635 5.666 2.635h4.849c.492 0 .896.167 1.212.5.316.335.474.73.474 1.187 0 .456-.158.852-.474 1.185-.316.334-.72.501-1.212.501h-4.849a10.08 10.08 0 0 1-4.374-.975 11.673 11.673 0 0 1-3.61-2.661 13.173 13.173 0 0 1-2.478-3.9A12.073 12.073 0 0 1 0 28.301c0-2.706.755-5.148 2.266-7.326 1.511-2.178 3.444-3.636 5.798-4.374.14-2.354.658-4.542 1.554-6.562.896-2.02 2.091-3.777 3.584-5.27 1.494-1.494 3.25-2.662 5.27-3.505C20.493.422 22.733 0 25.193 0c1.898 0 3.637.237 5.218.711 1.581.475 3.004 1.151 4.269 2.03a13.518 13.518 0 0 1 3.268 3.215 18.628 18.628 0 0 1 2.266 4.216Zm-11.964 13.44 6.22 6.85c.245.247.368.537.368.87 0 .334-.123.642-.369.923l-.421.263c-.211.246-.484.343-.817.29a1.544 1.544 0 0 1-.87-.448l-3.69-4.11v16.97c0 .492-.166.896-.5 1.212-.334.316-.729.474-1.186.474-.492 0-.896-.158-1.212-.474-.316-.316-.474-.72-.474-1.212V28.25l-3.584 4.005a1.544 1.544 0 0 1-.87.448.959.959 0 0 1-.87-.29l-.42-.264c-.247-.28-.37-.588-.37-.922 0-.334.123-.624.37-.87l6.113-6.746v-.052l.421-.422a.804.804 0 0 1 .396-.29c.158-.053.307-.079.448-.079.175 0 .333.026.474.079.14.053.281.15.422.29l.421.422v.052Z", fill: "none" }))); }
    Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Alternate Contacts

    Please tell us who we may disclose or release your information to.
  • *   *         Relationship   *         *       Information to be released   *  If Other please specify:       May we contact this person if patient is unavailable    *        

  •             Relationship                      Information to be released     If Other please specify:       May we contact this person if patient is unavailable            

  •             Relationship                   Information to be released     If Other please specify:       May we contact this person if patient is unavailable            

  • Clear
  •  - -
    Pick a Date
  • Name of person completing application if other than patient:

  • Should be Empty: