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Nick's House, Philadelphia Application

Contact Information



Enter numbers only, do not include $, commas or spaces

Monday through Friday between 9am and 3pm

Monday through Friday 9am to 12pm


Treating Physician Information

By clicking this button, you authorize HEADstrong Foundation to contact your medical team to validate this application and you have made them aware of your application for a stay at Nick's House

Other Guests Staying with Patient



Do you have more guests then just the caregiver staying with you?


Additional Information

Nick's House is ADA handicapped accessible.

We love to share patient/caregiver stories with our supporters. If you are willing, we will put you in contact with our marketing team for more details and to set up a time to share.

Electronic Certification

Residency applicants must meet ALL the following eligibility requirements to stay at Nick's House.
By clicking below, you are providing consent for us to reach out to you for a background check. This must be completed prior to our approval for your stay at Nick's House.
Nick’s House is not a healthcare facility and may not be used for the purpose of the administration of medical care or therapies, including, without limitation, palliative or hospice care. HF makes its residential facilities available for such persons from time to time, in the HF’s sole discretion. Use of residential facilities is subject to the rules and requirements of HEADstrong Foundation. All residents must sign a Nick’s House Guest Agreement, the form established by the HF. Length of stay is up to 6 weeks, extensions may be approved at the discretion of the board.
The undersigned certifies to HF that he/she meets the eligibility requirements of the Nick’s House Residential Services Program, as described in this Application, and that all the information provide in or with this Application is true and correct.