Patient Financial Assistance Program

Financial Assistance

Along with the stress of combating the disease itself, blood cancers bring with them a mountain of medical bills and out-of-pocket expenses. Co-pays, deductibles and prescription costs can leave you wondering how to pay the next bill.

If you live within 100 miles of Chicago or in the state of Illinois, the Leukemia Research Foundation may be able to help. We provide financial assistance to qualified patients and families. Our program reimburses almost any treatment-related expense not covered by your medical insurance.

*Please note:

Insurance premiums / COBRA premiums / Medicare premiums are not covered by this program.

Follow these steps to apply. Complete the application and return:

  • Completed application
  • A letter of diagnosis from your physician, and
  • Copies of your income tax returns for the last three (3) years

Mail all information to the Leukemia Research Foundation, Attn: Patient Financial Assistance Program, 191 Waukegan Road, Suite 105, Northfield, IL 60093. You may also email the form to

Application Guidelines

Application Form (fill-in)

Application Form (mail-in)

Reimbursement Form