Patient Navigation Questionnaire
This form is for assistance with Clinical Trial Navigation. Use this form if you would like our help identifying cancer clinical trial options for yourself or on behalf of someone else.
If you have questions please contact Lazarex Cancer Foundation directly for for help with clinical trial identification.
Financial Assistance Application
Use this form to request Financial Assistance for travel expenses to cancer clinical trial treatments for yourself or on behalf of someone else.
Please Note: We do not assist with expenses such as rent,
mortgage, utility payments, childcare, pet care, food or insurance deductibles.
If you have questions please contact Lazarex Cancer Foundation directly for assistance with clinical trial travel expenses.
Trial Verification Form (TVF)
Use this form to verify cancer clinical trial status for APPROVED & ENROLLED Lazarex patients only. Have a Medical Representative (oncologist, nurse, doctor, social worker or clinical trial coordinator, etc.) complete the form.
It is the patient’s responsibility to submit the completed form to Lazarex Cancer Foundation by the requested due date.
If you have questions please contact Lazarex Cancer Foundation directly for assistance.