Verification of applicant diagnosis instructions
This form must be completed by a healthcare provider (such as a social worker, nurse, navigator, or doctor). If you are not a healthcare provider, please do not complete this form. Please ask your provider to complete it for you.
The Living Beyond Breast Cancer Fund provides one-time financial assistance grants to people receiving active treatment for early-stage breast cancer, or who are living with metastatic breast cancer, and experiencing financial concerns. In order to be considered for a grant, the applicant’s healthcare provider must provide verification of breast cancer diagnosis.
Please complete this form on behalf of your patient by the close of the application period.
Demand for grants is very high. Please be sure that your patient meets our eligibility criteria (see “Am I eligible to receive a grant?”).
- LBBC will no longer offer grants to people currently diagnosed with stage 0 because of the high volume of applicants.
- Applicants must be receiving active treatment at the time of the application period.
- Living Beyond Breast Cancer defines active treatment for early-stage breast cancer as surgery (lumpectomy or mastectomy 30 days before or after the application close date), chemotherapy, radiation, targeted therapy (HER2 targeted therapies), and/or immunotherapy. Those with future treatment scheduled are not considered eligible at this time and are encouraged to apply once active treatment begins.
- LBBC cannot consider applicants who completed treatment for early-stage breast cancer and whose current treatment is limited to preventative treatments such as hormonal therapy (Tamoxifen or Aromasin, Arimidex or Femara) or targeted therapies (Kisqali or Verzenio), for a grant.
- In addition to the treatments listed for early-stage breast cancer, LBBC will consider hormonal therapy (Tamoxifen or Aromasin, Arimidex, or Femara) or targeted therapies (Kisqali, Verzenio, or Ibrance), as active treatment for metastatic breast cancer.
Incomplete or late submissions will not be reviewed, but applicants may apply again if they still meet eligibility criteria. The application will not be considered complete without the Healthcare Provider verification form.
By completing this form, you verify that your patient has been diagnosed with breast cancer. Click “I understand” to continue to the form.