Apply Now

Thank you for completing an application. We’ll get back to you as soon as possible.

Hands forming a heart shape. Black cuffs and simple lines.

We got it.

No One Fights Alone

Patient Assistance Application

Applications will be reviewed in detail assuring eligibility criteria have been met. This includes the following: Applicant resides in Lancaster County); has a verified cancer diagnosis; demonstrates financial need (income documentation reviewed); Request aligns with program purpose. Thank you for your interest in our programs and we look forward to speaking with you soon!

Applicant Information

This is required
This is required
This is required
Enter your phone number Enter a valid number like +1555-123-4567
This is required
Enter an email Use an address with (@) and (.)
This is required
This is required

Cancer diagnosis & Treatment verification

This is required
This is required
This is required
This is required
This is required

Household & Financial Information

This is required
Household income range
This is required
Do you rent or own your home?
This is required
This is required
This is required

Assistance Requested

Please check all that apply

This is required

Offers grocery and gas gift cards to ease daily burdens.

This is required

Provides 5 fresh, nutritious meals (Clean Eatz, Lancaster) per chemo cycle to patients in active chemotherapy who are facing financial, social, and nutritional distress.

This is required

Provides counseling services to support emotional healing in collaboration with Lindsay Webb, LPC, Lancaster, PA.

This is required

Assists with the cost of durable medical equipment like walkers, shower chairs, and compression garments.

This is required

Supports access to medical massage therapy to relieve pain and stress. In collaboration with Debra Heagy, Licensed Oncology Massage Therapist, Lancaster, PA.

This is required

Helps patients regain confidence with financial assistance for wigs, in collaboration with Classic Images Salon in Lititz, PA.

Patient Statement of Need

This is required

Authorization & Signature

I authorize Healing Journey Foundation to contact my treatment facility for verification and understand that assistance is subject to availability and intended purpose. By signing below, I affirm the information provided is accurate. By typing your full name below, you agree that this will act as your electronic signature.

This is required
This is required
This is required
This is required

Applications are reviewed weekly. Approved applicants will be contacted directly. If additional information is needed, we will reach out to you at the phone number or email address provided above.

Cartoon of a broken pipe with steam and explosion emanating from it.

That didn’t work.

The form wasn’t sent. Please try again.

A simple line drawing of a butterfly.

“Together, we rise above the hardships and find comfort in knowing we’re not alone.”