For your convenience the Financial Aid Fund online application area is available 24 hours a day, allowing you to submit an application for assistance through this secure area. Once you have completed the application, including all required fields of data and documentation, your application will be forwarded to our approval team for decision.

To insure the continued integrity of the program, all patients eligible for assistance are required to have a physician verify his/her diagnosis by completing and signing the Physician Verification Form and submitting it within 30 days of the patient’s application date. In an effort to ease the administrative burden on our patients, you will not be required to submit any income documents. Patient Advocate Foundation will be confirming your reported income to ensure that it is within the income eligibility guidelines for the program, through an automated income verification process. In the rare instance that the system is unable to verify that your income meets program income eligibility requirements, we will contact you in a letter to request income documentation.

We suggest you have the following information available while completing your application.

• Treating physician’s full name, office address, telephone number, fax number and/or email address
• Documentation that can be used to verify your current household income (i.e., 1040 form, pay stub)
• Health Insurance card (if applicable)

If you would like to begin the application process, and this is your first time visiting PAF’s Financial Aid Fund online application area, click Patient Registration below to create an account and begin your application. To check on the status of a previously submitted application, please click Check Your Application Status below.