Get ready to apply
The Blood Cancer Foundation of Michigan
Financial Navigation
What you get
A case manager helps you understand insurance, benefits, and bills and find outside financial help. Open now.
- Who starts it
- You
- How it’s sent
- Email to patientservices@bloodcancerfoundationmi.org
- Your time
- An hour or so
- Last checked
- Aug 27, 2026
Before you start, check you fit
- The form asks for a health professional's contact information.
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What their form asksA preview, so you can gather things first. Fill it in on their site.
Open the application PDF ↗ Checked Aug 27, 2026Send it by email to patientservices@bloodcancerfoundationmi.org.
What the form asks for
Patient informationToday’s datePatient’s Last Name: First: MiddleMr. / Miss / Mrs. / MsMarital statusHome PhoneCell PhoneEmailCurrent Treatment StatusPreferred Method of ContactBirth dateAgeSexPatient isStreet AddressCityStateZipMichigan County of ResidenceRaceEmployment: (If patient is a child, please list parent/caregiver employment info)Veteran StatusHousehold Income Level: (For informational purposes only. Services are not based on income.)Medical & insurance informationDiagnosisDiagnosis DateBone Marrow/Stem Cell Transplant DateTreatment CenterCityStateHealth Professional ContactTitle/PositionPhone NoDoes the patient have insurance? (Please include Medicare/Medicaid)Primary Health InsuranceSecondary Health InsuranceShow the rest of the form (2 more sections)
Referral and caregiver informationHow did you hear about BCFM’s servicesName of Primary CaregiverRelationship to PatientAddress: (if different from patient)CityStateZipHome PhoneCell PhoneEmailShould this person be the primary contact instead of the patientAdditional family information, needs, and certificationTotal Number of People in Household: ChildrenTotal Number of People in Household: AdultsList Names/Birthdates of Children Still Living in Home (other than patient): Name / DOB / SexAny additional information on your current needsSignatureRelationship to PatientDateHave ready
- Completed and signed 2026 BCFM enrollment form.
After you send
Save a copy and delivery evidence; call (800) 825-2536 if confirmation is not received.