Copy of Most Recent Treatment Plan. A Treatment Plan is a statement from your Oncologist indicating:
2) Treatment Applicant is Currently Receiving, and
3) Length of Applicant Expects to Receive Treatment for Cancer.
** DO NOT INCLUDE complete medical history, ie. record of office visits, or any documentation that does not pertain to the Treatment Plan.
Your Application will not be considered unless a Current Treatment Plan is provided.
Have you applied for food and medical assistance from the state of Florida? (Select One)
Please Upload a Letter of Assistance or Denial.
Amount of Rent / Mortgage:
Upload Lease Agreement or Mortgage Information
I understand and agree that the information supplied by me may be shared with other funding sources, and community services for benefits and planning on my behalf:
I attest that I am a resident of Monroe County and that I must pursue all relevant Federal, State, Local, Public and Private Resources for medical and financial assistance in a timely fashion before, and co-incidental with receiving any financial assistance from the Cancer Foundation of the Flrida Keys, Inc.
I understand that I may be ineligible for service if, at any time, I have been found to have deliberately misled any representative of the Foundation.