Preventive Health Checks

Application Process:

• Consult Your Healthcare Provider: Discuss your eligibility with your healthcare provider and obtain a recommendation.

• Application Verification and Notification Upon verification of the information in this application, both the patient and the physician will be notified of its completion. The patient will receive a notification at the address provided with a schedule and instructions for contacting The Crowns Project to verify all information.

• Timely Submission To ensure a timely start to your supply delivery, please submit this application at least one month before your scheduled procedure.

• Program Details The program provides a three-month supply of incontinence garments, with a recommended usage of three changes per day.

Programs and Resources to Help With Cancer-related Expenses

For individuals undergoing prostate cancer treatment, there are several programs and resources available to assist with expenses. These include:

• Medicaid: Often provides comprehensive coverage for medically necessary supplies, including adult diapers. 1

• Medicare Advantage Options: Some plans offer quarterly allowances for over-the-counter purchases, which may include adult diapers. 1

• VA Coverage Layers: Veterans can access supplies directly through VA health care or utilize "Aid and Attendance" funds to offset private costs

Goal Assist Application

We recommend downloading and reviewing the application before completing it online.

How to Print

• When the document opens in a new tab, look for the Print icon at the top of the viewer.

• Click Print to open your print settings.

• Choose your printer and confirm.

Keyboard Shortcut Option

• On Windows: Press Ctrl + P

• On Mac: Press Command + P

Complete the Online Referral Form

If you don’t have Adobe Reader—or prefer an easier, faster option—use our online form to complete and submit your referral directly from your browser.