Financial Assistance Form

The Clearity Foundation is a 501(c)(3) not-for-profit, founded by an ovarian cancer survivor and scientist, dedicated to helping ovarian cancer patients make more informed treatment decisions with personalized diagnostic information. We have been helping patients acquire and interpret their tumor blueprints for over three years. We rely on the financial support of community organizations, corporate sponsors, individual donors and the patients we serve to provide this assistance to patients.

The Clearity Foundation provides its patient support services, including diagnostic test coordination, tumor blueprint interpretation and clinical trial identification, free of charge to the patient. In addition, Clearity may be able to help patients pay for the costs of diagnostic tests. If you meet the clinical criteria below you are eligible for financial support from The Clearity Foundation:

  • I am having a recurrence since my first diagnosis and my doctor has planned another surgery or a biopsy to remove tumor tissue
  • I have had a recurrence since my first diagnosis and another surgery or biopsy was performed to remove tumor tissue during the last two years
  • I am having a second or third recurrence and I have had a surgery or biopsy to remove tumor tissue in the last year

We are committed to helping women with ovarian cancer make more informed treatment decisions regardless of her ability to pay and our grant process exists as a way of identifying patients that need financial assistance. As long as Clearity Foundation has the financial means to do so we hope to grant every financial assistance request.

First Name:

Last Name:

Email:

Phone:

Do you have insurance?
  If yes, what kind?
How much do you expect to be billed for diagnostic services (after insurance, if applicable)?
$
How much can you afford to pay?
$
How much assistance are you requesting from The Clearity Foundation?
$
Would you consider being a fundraiser in the future to help another patient in need (yes/no)?
Is there anything else you would like The Clearity Foundation to know?