Before you begin, here's what you'll need:

• Proof of income (most recent tax return and/or W-2), plus additional income documentation if that doesn't reflect your current situation
• Household size and information about any dependents
• Your insurance information
• Documentation of your remaining medical debt (a provider statement for each bill)
• Confirmation that you've completed a free charity care screening with our partner, Dollar For
• A signed letter from your surgeon confirming your reconstruction surgery. Download the letter template here and have your surgeon complete it before you upload it.
• Your electronic signature

This application takes about 15–20 minutes to complete once you have your documents in hand. Before you can finish it, though, you'll need to complete your free Dollar For screening. That process alone typically takes 6–10+ weeks, so start it as early as you can.

You don't have to finish everything in one sitting. You can save your progress at any time and come back later using the Save button.

If you have any additional questions or need assistance, email alli@thebreastfund.org.