PLEASE READ THE INFORMATION BELOW PRIOR TO COMPLETING THE APPLICATION
Welcome to CoastBusters Cares! This program is designed for people who are experiencing financial hardship while currently receiving breast cancer treatment (i.e. pre-treatment, during treatment and post-treatment) and live in Lincoln County, Oregon.
Distribution Per Fiscal Year (1/1/25-12/31/25): Yearly limits apply and are subject to fund availability.
Applications will be reviewed and responded to within 6-8 weeks. Completion of the form does not guarantee approval for funding.
Step 1: Patient Must Complete the Release of Information (ROI) Form
A completed Release of Information (ROI) Form is now required for enrollment in this program. This form should be completed by the patient or their authorized representative (e.g., Guardian, Executor of Estate, Health Care Power of Attorney).
Step 2: A Care Provider Must Complete This Form
The form below must be completed by a care provider, not the patient.
