Apply for Financial Assistance

Application for Financial Assistance

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A major goal of MiraKind is to make meaningful genetic information accessible to those who can benefit from this knowledge. We therefore try to support as many seeking assistance as possible.

Before applying, be sure you meet the testing access eligibility requirements: the KRAS-variant, PROSTOX, or PrevIOTOX.

Name*

First Last

Email*

Enter Email Confirm Email

Which test do you need financial assistance for?*

KRAS-variant

PROSTOX ultra

PROSTOX CFRT

Both PROSTOX ultra & PROSTOX CFRT

PrevIOTOX

Reason for wanting testing (check all that apply):

Personal history of cancer

Family history of cancer

Making decisions regarding estrogen therapy

Check all that apply:

You have a prostate cancer diagnosis

You have not received radiation treatment to the prostate

You are considering Stereotactic Body Radiation Therapy (SBRT) for prostate cancer

Check all that apply:

You have a prostate cancer diagnosis

You have not received radiation treatment to the prostate

You are considering Conventionally Fractionated Radiation Therapy (CFRT) for prostate cancer

Check all that apply:

You have a prostate cancer diagnosis

You have not received radiation treatment to the prostate

You are considering Stereotactic Body Radiation Therapy (SBRT) and/or Conventionally Fractionated Radiation Therapy (CFRT) for prostate cancer

Check all that apply:

You have a cancer diagnosis

You are considering anti-PD1 or anti-PDL1 immunotherapy treatment

Annual Household Income*

Number of Individuals in your Household (as reported on your taxes)*

City & State

Employment status*

Reason for requesting financial assistance*

Disclaimer

Any discussion of medical management options on this website is for general informational purposes only and does not constitute a medical recommendation. All medical management decisions should be made based on consultation between each patient and his or her healthcare professional.

Apply for Financial Assistance

Application for Financial Assistance

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