Pregnancy Complication Financial Assistance | Colette Louise Tisdahl Foundation

Acceptable verification has to fall under one of the following categories:1. A healthcare provider verification form submitted online on agency website at www.colettelouise.com that is appropriately filled out by the third party with complete name, title, and contact information.2. A healthcare provider writing a letter on the appropriate letterhead and emailing said letter directly to agency at [email protected]. The email must come from whoever wrote the letter and it must be from their official work email and include their full name and contact information in either the letter or the email.3. In cases of loss documentation submitted or sent from either healthcare provider or parent applying that is official government or hospital paperwork. This may include a death certificate, the official paperwork that hospital completes for a death, or a detailed medical write up (not discharge paperwork) that shows the logo and contact information for the hospital or doctor as well as contact information for follow up.

Mon 12:00am - 11:59pm Tue 12:00am - 11:59pm Wed 12:00am - 11:59pm Thu 12:00am - 11:59pm Fri 12:00am - 11:59pm Sat 12:00am - 11:59pm Sun 12:00am - 11:59pm Online application form is available 24 hours a day, 7 days a week.

English

Other languages may be available.

Prospective client fill out and submit online application formHealthcare provider fill out and submit online verification formhttps://colettelouise.com/pregnancy-nicu/

No fees

United States