Request Assistance | Lorielife Legacy

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HOW CAN WE HELP YOU?

APPLY NOW!

FINANCIAL ASSISTANCE: Cancer care can be expensive, we may be able to help. We help with co-pays, medical bills, alternative cancer treatment costs, and every day expenses like utility assistance, mortgage or rent.

Need help understanding the options?

CANCER ADVOCATE: Need someone to be at your oncology visit so you don't go it alone, we can help. We can be a shoulder to lean on, and possibly help you know what questions to ask your doctor, and provide you a summary of your visit so you can better understand what you discussed with your doctor. This is a free service, yeah free! Service area includes Birmingham Alabama, Talladega County, Calhoun County.

We require 5-business days advanced notice to accompany you on a visit to your oncologist.

Cancer Advocate Request Form

First Name

Email

Last Name

Phone

Physician's Name & Clinic

Clinic/Office Location

Date & Time Of Appointment

Choose a time

Message

This appointment is 5-business days or more beyond this request submission date.

Thanks for submitting!

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