Written by a parent, not a doctor. Nothing here is medical advice.

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CancerCare

Acute Lymphoblastic Leukemia Co-Payment Assistance

What you get

A $7,000 initial grant toward acute lymphoblastic leukemia copayments, with a $10,000 program cap. Open now.

Who starts it
You, with a document from your doctor
How it’s sent
Email to information@cancercarecopay.org
Your time
About 30 minutes, plus waiting for the document
Last checked
Aug 27, 2026

  1. Ask your doctor for the documentStart here. This is the part that takes the longest.

    CancerCare needs a signed confirmation of the diagnosis from your doctor. It has to cover 3 things. Copy this message, or say it in person at the next visit.

    Hi [doctor’s name],

We’d like to apply to CancerCare’s Acute Lymphoblastic Leukemia Co-Payment Assistance. A $7,000 initial grant toward acute lymphoblastic leukemia copayments, with a $10,000 program cap. They are taking applications now.

They need a signed confirmation of the diagnosis from you. It has to cover primary cancer diagnosis must match the ALL fund, current chemotherapy or targeted treatment, and medication and expected treatment length. Their form and instructions are here: https://www.cancercare.org/services

Could you do that when you have a chance? I can send you the link, or bring a printout to our next visit. Thank you for everything you do for us.

[your name] · [phone]
    Copying is the only thing this page does with your text. Nothing is saved.

  2. Fill in their applicationIt is on their website.

    Open their application ↗ Checked Aug 27, 2026

    What the form asks for

    Treating physician verification · your care team fills this in
    Patient NameDate of BirthThe patient's primary cancer diagnosis isDiagnosis ICD-10Date of DiagnosisMetastatic Disease Yes / NoDisease Subtype as applicableMedication NameTreatment PlanExpected Length of TreatmentPrescribing Physician First Name Last NameAddress; City; State; Zip CodePhone; FaxNPI #Office ContactPhysician's Signature; Date

  3. Email your application and the document togetherTo information@cancercarecopay.org. Your doctor can send it instead if the document has to stay with them.

    • Start enrollment through CancerCare's secure form or by phone at 866-552-6729.
    • Return the physician verification through CoPayConnect, fax 212-601-9760, or information@cancercarecopay.org.

    Email: information@cancercarecopay.org

    Fax: 212-601-9760

    Subject: Acute Lymphoblastic Leukemia Co-Payment Assistance application, [child’s name]

Hello,

Attached are our completed application and the document from [doctor’s name] at [hospital]. Please let me know that it arrived and if anything is missing.

Thank you,
[your name] · [phone]

After you send

Allow 10 to 15 business days for physician-verification review and check status in your child portal. If you have not heard back by then, write and ask.

Full record, as published