Apply for a Grant

Do you need help getting a second opinion?

The Mike Shane Memorial Fund provides grants for patients to receive a remote written second opinion, meaning you do not have to travel. A second opinion can provide an alternative diagnosis or treatment plan or even confirm your initial diagnosis.

To qualify for this grant and receive this service, the patient must meet the following criteria:

Has received a diagnosis of cholangiocarcinoma
Not currently - nor will be at the time of consultation - a registered inpatient at any hospital
U.S. Citizen or lawful Permanent Resident

Please submit the form below to begin the application process. Upon submission, we will be in touch directly regarding the next steps. If you have any questions, please contact us: michelle@mikeshanefund.org | (800) 501-1537 ext 3

Please note: by submitting an application with the Mike Shane Memorial Fund you agree to be contacted regarding your experience with the fund. We will not request any medical information or details about your second opinion, only feedback regarding the application process to help spread the word for future grant recipients.

The Mike Shane Memorial Fund and all medical partners, have the right and ability to deny or refuse any request for a second opinion.

Begin Application

If you are submitting this on behalf of the patient, please include your first and last name, email address and phone number. Please indicate if we should contact you or the patient directly.

How did you hear about the Mike Shane Memorial Fund?

I understand that to qualify for this grant and receive this service, the patient must meet the following criteria: Has received a diagnosis of cholangiocarcinoma Not currently - nor will be at the time of consultation - a registered inpatient at any hospital U.S. Citizen or lawful Permanent Resident

I agree to share my experience of working with MSMF once my remote second opinion is completed

I acknowledge that the Mike Shane Memorial Fund may use the contact information I provide here to contact me about their services, as requested. (You may unsubscribe from these communications at any time. For information on how to unsubscribe, as well as our privacy practices and commitment to protecting your privacy, please review our Privacy Policy

Thanks for submitting your application! We will be in touch with you shortly about next steps.

Apply for a Grant

Do you need help getting a second opinion?

​

Begin Application