If you are an existing client who is faced with financial burden due to medical bills, an upcoming surgery, need for nurse care or other special services pertaining to your medical condition, we want to hear from you.

Please use the form below to tell us about your situation. Our determination will be based mainly on your explanation therefore we ask that you be as detailed as possible allowing us to understand your current situation and need.

Upon receipt, we will review and provide a response within 7-business days.

Please Note: This form is for existing clients only due to the time demands of these fundraisers. It is our goal to extend our reach to the Southern California community in the near future.  Thank you.