and Consent Form
This is Helomics' authorization, release, appointment and assignment form. It allows Helomics to complete insurance appeals on your behalf so you can focus on recovery. Your signed consent not only protects you, it also protects our clinical colleagues and facilities and may enable your tumor sample to further cancer research
and benefit future patients.
This information packet is intended to answer your questions about all Helomics testing, including the Chemosensitivity testing (ChemoFx®) and how the tests can benefit you. The packet will also ensure that all of the necessary forms are submitted properly.
If you are ultimately denied coverage for Helomics testing, have a large copay/deductible, or do not have insurance we encourage you to call and discuss our compassionate care program with our Managed Care Financial Services Department.