We’re Here to Help

Russel Hill Cancer Foundation is a local 501(c)3 non-profit organization dedicated to improving the health of North Alabama cancer patients and their families through research, education, and patient assistance.

Russel Hill Cancer Foundation is proud to offer financial assistance to patients currently receiving treatment for a cancer diagnosis in Huntsville and surrounding areas.

Financial assistance includes rent and mortgage payments, utility bills, medication expenses, medical supplies, etc. Russel Hill Cancer Foundation does not offer financial assistance towards any medical bills.

Please fill out the below application if you are in need of financial assistance

Name

First

Last

Phone

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cancer/Treatment Information

What oncology practice do you receive care from:

Who is your Oncologist?

What is your diagnosis?

When were you diagnosed?

Are you on active treatment?

Yes
No

If you are on treatment, please name the type of treatment (chemotherapy, radiation, surgery, etc.) and dates:

Please provide proof of treatment:

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Financial Information

What is your household size and income?

Please explain why you need financial assistance:

If you are needing assistance with a bill, please attach the bill with due date included

Drag & Drop Files, Choose Files to Upload

If the bill is not in your name, please provide proof of living situation: (i.e. lease, marriage license, etc.)

Drag & Drop Files, Choose Files to Upload

Are you receiving assistance from anywhere else?

Yes
No

If so, where?

please this so,

By checking this box, I am acknowledging that submission of this application does not ensure eligibility or approval for assistance from RHCF

I agree

Please allow up to 2 business days for us to get back to you!

We’re Here to Help

Cancer/Treatment Information

Financial Information

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