CARING, SERVING, SUPPORTING
Patient Aid Application - Frequently Asked Questions

How do I access the application?

The application is available for download on our website here. If you do not have access to a printer, please contact the Leukemia Texas office at 214-265-7393 and we can mail an application directly to you.

What do I need to send with the application?

The only documentation that you need to submit is the application and a current photo of the patient. However, this application must be completed with all required signatures and information. Please note that if the application is incomplete, late, or not legible, the application will not be accepted - no exceptions.

 When will I find out if my application has been accepted?

If your application is accepted, you will receive notice from Leukemia Texas within 3 weeks of the application deadline listed at the top of your application in red. Please do not call to check the status of your application during the 3-week process.

What diagnoses are eligible for patient aid?

The Leukemia Texas Patient Aid program is reserved for persons diagnosed with leukemia (ALL, AML, CLL, CML). 

How much patient aid am I eligible for?

If your application is accepted, you may receive a grant of $1,250 in patient aid to assist with treatment costs and access to care. If you have already received a grant from Leukemia Texas in the past, we ask that you wait one year before resubmitting an application to be considered for additional aid.

How do I send my application to Leukemia Texas?

You may submit your application either by mail, email, or fax. *Please know that if the application is not legible, it will NOT be considered. Therefore, mailing and emailing is the preferred method.

Mail to: Leukemia Texas

                      4925 N O'Connor Rd. 

                      Suite 125

                      Irving, TX 75062

                Or  Email to: patientaid@leukemiatexas.org

                Or Fax to: 214-265-8577  Attn. Program Manager

Why do you need a doctor's signature?

It is very important that the doctor, physician assistant, or nurse practitioner attest to the leukemia diagnosis and need for assistance through the Leukemia Texas Patient Aid program. In addition to your doctor’s signature, an additional member of the medical staff (i.e. Social Worker, Financial Advisor, Practice Manager) must sign the application. This requirement is to ensure that the applicant is in need of financial assistance due to the expenses incurred from having leukemia.

Why do you request a photo to accompany the application?

This request is optional so it is not required to complete the application. However, the reason we ask for you include a photo is so that in the event  that you are selected to receive aid, we are able to put a face to the person who is benefiting from the Leukemia Texas Patient Aid. If you do decide  to share your photo(s), DO NOT FAX the photo. (It is ok to fax the written application)

What are the eligibility requirements for a LeukemiaTexas patient aid grant?

You must be diagnosed with leukemia and be under the current treatment of a licensed physician and you must be both a U.S. citizen and legal Texas resident.

My question is not answered here, how do I contact Leukemia Texas directly?

Please feel free to contact our office at 214-265-7393 or email us at info@leukemiatexas.org