Advancements Guidelines Programs Patient Enrollment Apply

Apply

To apply for assistance, please fill out the following form or Contact Us during normal business hours. If we are unable to answer your call due to call volume, please leave a message and your call will be returned as soon as possible.

You must print out an Application and HIPAA Authorization and fax them to (214)-975-1114 or mail them to:

CDFund
10880 John W. Elliott Drive
Suite 400
Frisco, TX 75034

If you cannot print these documents, please fill out the form and we will send them to you.

Name:
Phone Number:
Best time to Contact:
Email:
Diagnosed Disease:
Medication Required:
State of Residence:
Annual Household Income:
Number of people in Household:
Insurance Company Name:
Prescription Deductible/Copay Amount: