PATIENT & FAMILY ONLINE PORTAL

The ZERO Drive Program provides transportation support to prostate cancer patients undergoing treatment, receiving follow-up care, and attending ongoing provider appointments related to a prostate cancer diagnosis.


Required Information for Online Application:

For your convenience, the ZERO Drive Program online application area is available 24 hours a day, allowing you to register and apply for assistance through this secure area. First time applicants will select Patient Registration and complete the required fields. Once complete a confirmation email will arrive in your inbox, please confirm within 2 hours and create a password.

Having the following information will be necessary to complete the online application:

  • Patient demographics to include full name, mailing address, phone number(s) and valid email address, marital status, ethnicity, gender, veteran status, employment status, social security number or alien number and date of birth
  • Authorized Person contact information (if applicable)
  • Health Insurance Information: Please note, Insurance is not required for eligibility
  • Treating Physician Information - (Physician Name, address, practice name, phone, and fax number)


All patients eligible for assistance are required to have a physician verify their diagnosis and treatment status by completing and signing the Physician Verification form. Our program specialists will fax the Physician Verification form directly to the provider's office once the application is completed and will follow-up with the treating provider if the form has not been received with 15 days of the application date.


The ZERO Drive Program will be confirming your identity through an automated verification system. In the rare instance that the system is unable to verify the information provided, we will contact you in a letter to request identification documentation.


If you have not registered for this program, select Patient Registration to begin the process of applying for an award.


To check the status of a previously submitted application please click Check Your Application Status here.


View Program FAQ
View Program Visa Card FAQ


Application system requirements include:

  • Internet Explorer 8 or higher
  • Google Chrome 30.0.15 or higher
  • Firefox 4.0
  • Adobe Reader 9 or higher version
  • File size uploads are limited to 2MB
  • These devices are not compatible mobile devices: iPhone and tablets including iPad

Please note: Cookies must be enabled. Cookies are usually already enabled, but refer to your browser's help documents for instruction on how to enable cookies if they are disabled. If cookies are not enabled, you will not be able to log in, and will see the log-in page repeatedly.

Older versions of these browsers, or browsers not listed here, may not work. Please use one of the browsers listed above for full functionality. Each one is free, widely available, and often pre-installed on many computers.


For questions regarding the ZERO Drive Program, please contact us at 1-844-244-1309, Monday through Thursday between the hours of 8:30 a.m. and 5 p.m. EST and Friday between the hours of 8:30 a.m. and 4 p.m. EST. We look forward to assisting you!