Financial Relief Fund Form
Please review carefully the detailed information located on our website about the Relief Fund. This is not the application for financial aid but a program to help you to raise support with our help. If you are looking for financial aid, please check our website to see if you qualify and fill out the application.
If you are still interested in the relief fund, upon completion of this form, a Patient Care Specialist will follow up within 1-2 businesses days. Our relief fund is currently only open to those located in the Tri-State area of Pennsylvania, Delware and New Jersey.
If you have any questions, please email support@HEADstrong.org
If you answer "no" to either of the following questions, a Fighter Relief Fund may not be a good option for you: