Doctors & Referring Professionals

PLEASE NOTE: THIS INFORMATION ONLY APPLIES TO REFERRING MEDICAL PROFESSIONALS 

If you are an individual requesting assistance please CLICK HERE TO START APPLICATION.

 

Any application received from a personal email WILL NOT BE ACCEPTED.

 

Referring Professionals: Please ensure your patients meet the following requirements BEFORE APPLYING:

  1. Patient is actively in chemo, radiation or has had cancer-related surgery in the last 18 months
  2. Resides within Bartow, Cobb, Carroll, Cherokee, Douglas, Paulding or Pickens County
  3. Needs financial assistance due to hardship from a recent cancer diagnosis

If your patient meets the above needs please complete the following application.

 

ALL APPLICATIONS MUST BE SIGNED BY A MEDICAL TEAM MEMBER AND RETURNED VIA EMAIL OR FAX. 

 

NO APPLICATIONS WILL BE ACCEPTED FROM PERSONAL EMAIL OR FAXES

 

Please feel free to download the application to reuse as needed. If you have any questions please contact us.

 

Download New Patient Application:

NEW CLIENT APPLICATION

 

Download a description of our services to reference:

Service Description Loving Arms

 

WE DO NOT ASSIST WITH MEDICAL BILLS, CO-PAYS, RENT OR MORTGAGE PAYMENTS. 

If a patient resides within COBB COUNTY and is in need of rent/mortgage or grocery assistance they may be able to receive help through the ARPA program funded by the county. Please learn more here https://lovingarms.support/arpa-info/