top of page

*Pink Hands of Hope is a non-profit organization whose mission is to assist people battling cancer. The Helping Hands program is designed to help patients with mounting medical bills. Approval of applicants is based on availability of funds for this program.

You must reside in one of the participating counties, Adams, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Perry, Schuylkill, Snyder, or York.


Step 1: If you are a cancer patient with unpaid medical bills (not covered by insurance or grants), please complete the online application. If you prefer, you can DOWNLOAD the application and return it by email or regular mail.


Step 2: Once the application is received and reviewed, it will be forwarded to the Pink Hands Board of Directors for approval (based on availability of funds) up to $1500. Please note this step is completed within a very short period.


Step 3: When the approval is complete, you will be contacted by Pink Hands of Hope to discuss payment of the outstanding medical bill(s).


Step 4: Once we have received the copies of the outstanding medical bills, Pink Hands will cut check(s) directly to your provider.


If you have any questions regarding this application process, or any other questions for Pink Hands of Hope, feel free to email us at info@pinkhandsofhope.org or call at 717-620-8264.

HELPING HANDS APPLICATION

APPLICANT INFORMATION

State
Date of Birth

DIAGNOSIS AND HEALTH INSURANCE INFORMATION

Date of Diagnosis
Oncologist State
Do you have health insurance
Yes
No

FINANCIAL INFORMATION

Has your diagnosis affected your ability to remain employed?
Yes
No

By signing below, you give permission to Pink Hands of Hope to contact your medical professionals regarding your

medical and financial information:

bottom of page