We are proud to offer assistance to those in need.
A cancer diagnosis can be an overwhelming financial burden. CryoGam has partnered with LIVESTRONG to offer a Fertility Discount Program for qualified male patients facing cancer treatment.
What do I need to apply?
The application consists of three parts:
1.) Patient Authorization and Consent Form - to be completed and signed by the patient and/or patient's parent or guardian if under age 18
2.) Oncologist Referral and Certification Form - to be completed and signed by his oncologist
3.) The patient's or patient's parent's/guardian's most recently submitted 1040 Federal Tax Return Form
How do I get started?
- Click here for the online application!
- Please visit our Resources Page to find out more information on infertility and cancer.