Client Assistance Request Form

Please be aware there is a waiting list at this time, we are working as quickly as possible but the wait time is currently 3-4 weeks .


For faster service please fill out our online "Request for Assistance" form located at the bottom of this page. 

Mission of Hope Cancer Fund provides Direct Financial Assistance to cancer patients and their families during treatment and recovery for ALL cancers and ALL ages! Currently our financial support is only available to Michigan residents.

For your convenience our evaluations take very little time, in most cases 15 to 20 minutes over the phone.


Our Office Hours:  Monday to Friday 10 am to 3 pm.

Jackson Local Phone: 517-782-4643

Fax: 517-858-9200

E-mail: mhcf@cancerfund.org


To help save time, you will need the following information: original diagnosis date, dates and information about your treatment, i.e. surgeries, chemotherapy, radiation and insurance information as well. Then we can tell you how we may be of help with your financial needs.

Assistance Available
  • Prescription(s) or co-pays
  • Lodging (for stays next to treatment centers)
  • Travel costs
  • Insurance Premiums
  • Medical Equipment & Supplies
  • Medical Expenses
  • Help Locating Grief & Emotional Support Groups
  • Having a cancer benefit? We can help!
All needs are subject to stipulations. Assistance is 
provided on a first come first serve ,case by case basis, 
and as funds are available.
Please read information about our service programs and areas served before completing this form. Please specify a best time to call between 10 a.m. - 3 p.m.

 *MHCF is assisting Michigan Clients only at this time.

Client Assistance Request

Prescription Costs and Co-pays
Health Insurance Premiums
Medical Equipment & Supplies
Medical Expenses
Lodging
Travel Expenses
YES
NO