Let's Talk about How GYNCA can help

In order for GYNCA to best serve women diagnosed with a gynecologic cancer, we need to better understand how we can help.

Click on the form names below, download, print and fill in the information requested (your physician’s office is responsible for the medical form). You may only need survivor-to-survivor mentoring, a visit to our monthly support group meeting or you might qualify for emergency non-medical financial assistance- whatever the need, please start by filling out the Member Application so we can help you and your family through the daunting process of dealing
 with a gynecologic cancer diagnosis.

If you don’t have access to a printer or fax machine, ask your physician’s office staff to print a copy- they’re always willing to help!

You can fax the completed documents to (417) 869-2221, or mail to the address at the bottom of the forms.

You can always call the office at (417) 869-2220, and we’ll send a set of forms to your attention.

We also have many community resources that may be able to meet a need we don't have listed.

Contact the office for individual assistance in locating these.
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Welcome

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GYNCA's Priority Partners

New Patient Forms & Information


Please Complete The Forms Below & Return Them To GYNCA
 
Member Information
(To Be Completed By Member)
 

Financial Application
(To Be Completed By Member)
 

Patient Eligibility
(To Be Completed By Member)
 

Non-Medical Financial Payment Request Form (To Be Completed By Member)

Partnerships with the following Organizations
**Please contact our office for additional information**

Imerman’s Angels

A nationwide mentoring program to help individuals and their caregivers deal with a cancer diagnosis.

Jasper

A web based organizational tool to help track essential information during your diagnosis, keep track of appointments, and send reminders regarding your treatment.

Breast Cancer Foundation of the Ozarks

Helping individuals with breast cancer.  BCFO will make a referral to our agency to receive a free wig, wig stand, care instructions and a special gift bag.

Brigitte’s Wig Boutique

Will cut GYNCA wigs to frame your face at no charge.

Description of Services

Case Management Services
As a member receiving active treatment, you will be contacted by our Community Development Coordinator when your paperwork is received for a specialized case management consult.  Questions, concerns, and individual situations will be evaluated to make the best referrals for your specific needs.  Our Community Development Coordinator will contact you at least monthly to continue to assess your needs, answer questions, and offer support while you navigate your treatment.
 


Fueled by Hope
Gas cards are provided to clients in active treatment to ensure your ability to make it to and from your appointments.  Our goal is to remove barriers to your treatment, and it is our hope, these gas cards will take some of the financial burden off you and your family.  Currently our gas cards are provided by Rapid Roberts.  We understand that some areas do not have Rapid Roberts and, in this case, please let your Community Development Coordinator know so other arrangements can be made.  Once a month, around the 15th gas cards are mailed out and amounts of gas cards are determined on an individual basis, considering the frequency of treatment, miles driven, and current gas prices.
 

Please note ** These cards are only available when in active treatment.Once treatment is completed, financial assistance is no longer available.
 

Non-Medical Emergency Financial Assistance
Each client in ACTIVE treatment has access to a $500 lifetime non-medical emergency fund.  This is determined and approved on an individual basis.  If we are unable to locate additional resources to help a financial need and after obtaining approval, we can assist financially for non-medical needs. These funds are not a guarantee but are evaluated by our Community Development Coordinator and approved by Board Members if it is deemed appropriate.  We have assisted individuals with rental and utility assistance, auto repairs, lodging, and emergency home repairs.
 

Please note **This assistance is only available when in active treatment.Once treatment is completed financial assistance is no longer available.

Many times, individuals diagnosed with cancer lose their hair during treatment.  We have always said “It’s not JUST hair”, it is so much more, and we want to make sure that each of our clients are able to maintain as much normalcy in their life as possible.  To do this we assist with providing a free wig, wig stand, care instructions, and a special gift bag for each individual to pamper themselves with. We want to help build confidence and let you know that we care.  You are beautiful and so much more than your diagnosis!

We have a member’s only Facebook page where those who have had or are currently fighting a gynecologic cancer can have a safe space to ask questions, discuss feelings, concerns, and celebrate milestones with others with in a similar situation.

Monthly support meetings are held to discuss hot topics, gather information, and provide emotional support to each other.