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 Criteria and Application for men. Please note the following message from LiveStrong: "While the program's eligibility requirements and services remain unchanged, it is important to note that effective April 1st previously downloaded applications will no longer be accepted as they have been replaced by the online portal option. For those who prefer direct assistance, please call 855-220-7777 to speak with a live LIVESTRONG Fertility application specialist."
- Click here for the online application!
- Please visit our Resources Page to find out more information on infertility and cancer.