Small Gift Requests
When submitting your applications please follow the detailed instructions outlined below.
This is the only way to ensure your application is reviewed and processed.
Before completing the application please review the following guidelines:
If you have access to Docusign, it may be used to obtain the required signatures. However, the instructions below MUST be followed!
Please follow the steps below to submit a Small Gift Application
* Applications must be submitted by a member of the patient's hospice or palliative care team.
** NOTE: We do NOT provide reimbursement for payments already made or items purchased
** The bill or invoice must be in the adult patient's name for which the relief fund is being rewarded.
1. Download and complete the application
2. Once all required information is obtained, please submit the the application and other documents by emailing them in PDF form to email@example.com
4. Please provide feedback for us to use for marketing purposes
** If you require additional assistance please reach out to us by calling 855-219-1648 or by emailing us at firstname.lastname@example.org.