Whether your child has been diagnosed, or you’ve been diagnosed as an adult, blood cancer treatment can be overwhelming financially, emotionally, and physically. At The Blood Cancer Foundation of Michigan, we take a holistic approach, supporting you and your family every step of the way. BCFM is committed to providing information, emotional support, financial assistance and events and opportunities for fun to help you maintain your quality of life.

Who Is Eligible for BCFM Services?

  • Michigan Residents
  • Adults and Children Diagnosed with a Blood Cancer or Blood Related Disorder
  • No Age Limits
  • No Income Requirements

Our services are free of charge and are available for both child and adult patients. Please call 800.825.2536 for more information.

Enroll Online Now using the below form or Download the Enrollment Form.

Patient Information

Patient's Name(Required)
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Can your Patient Support Specialist text your cell phone?(Required)
Address(Required)
Veteran Status(Required)
For informational purposes only. Services are not based on income.

Medical and Insurance Information

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Treatment Center Address(Required)
Does the patient have insurance? (Please include Medicare/Medicaid)(Required)

Referral Information

How did you hear about BCFM's services?(Required)

Caregiver Information

Name of Primary Caregiver(Required)
Is the Caregiver's address the same as the Patient's?(Required)
Should this person be the primary contact instead of the patient?(Required)

Additional Family Information

List Names/Birthdates of Children Still Living in Home (other than patient)(Required)
Name
DOB
Sex
 

Additional Information and Comments

Terms of Service(Required)

*In order to best support you, BCFM works with non-profit partners, and may confidentially provide your information to other non-profits or healthcare agencies and may request information about you from these agencies. BCFM will never sell your information or share it with solicitors.

I certify that this information is true to the best of my knowledge and I agree to the terms listed above as of the date indicated below. I understand that The Blood Cancer Foundation of Michigan is a non-profit, community organization. Provision of services is subject to approval by the BCFM Board of Directors and may be discontinued at any time with or without notice. BCFM will contact me upon receipt of my completed application.

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