All patients requesting assistance with gas cards or vouchers, must fill out the Patient Application Form in its entirety, leaving no lines blank.
Gas Card Eligibility Requirements:
Currently undergoing treatment
Traveling 20 miles or more, one way, for treatment
Must meet financial hardship guidelines
Voucher Eligibility Requirements:
Currently undergoing treatment.
Must meet financial hardship guidelines
Application Process:
Patient must fill out the Patient Application form in its entirety, including the demographics section.