How to Apply for Assistance

Download and complete the application at the bottom of this page, apply first-class postage, and mail to the address on the form. Applications will be reviewed, and if approved, payment will be sent to the provider. Applicants will be contacted if any questions arise.

Proof of diagnosis may be required.

Expenses Covered

Due to variations in health insurance coverage, some aspects of the diagnosis and treatment of breast cancer may not be covered. The Pink Ribbon Angels want to help cover those out-of-pocket expenses to ensure the best care possible.Some of the products and services we will help cover include;

  • Mammograms (both screening and diagnostic)
  • Wigs
  • Co-pays (Doctor and prescription)
  • Prosthetics
  • Gas costs for travel to Radiation treatments
  • Other requests will be considered on an individual basis

Download

Click on a file to download.