Lynx Dx CARES
Financial Assistance Application

I hereby acknowledge that:*

• The above information is true and correct according to the best of my knowledge.
• Program availability is not guaranteed and may be limited or unavailable in certain states or certain health insurance plans.
• Income may be verified independently. Lynx Dx reserves the right to request documented proof of financial need. I should be prepared to provide financial documents as required.
• I authorize the release of any financial records necessary to verify the above information.
• I understand that submission of this application does not guarantee approval of financial assistance.