Financial Assistance Application


This document is for use by a Medical Representative only (social worker, clinical trial coordinator, doctor or nurse, etc.) and is password protected. We will continue to make changes to this document so please return here to print the most current version. Older versions of this application will slow the process.

If you are a patient, please contact Lazarex Cancer Foundation directly for assistance with clinical trial expenses or for help with clinical trial identification.

To Download the  Financial Assistance Application, click pdfhere


Click here for Applying for Financial AssistancepdfLazarex_Application_for_Assistance.pdf