Medical Aid Questionnaire

As a matter of policy, we do not ever give cash directly to the patient / individual or family who applied for assistance

via Hugs For Mito, Inc. 

 

We assist the individual or family who has requested our assistance by remitting payment directly to the vendor or creditor whom we receive durable medical equipment and supplies.  

By operating in this manner, our donors can always be certain that the contributions they've made available to our qualified patients and families serve only the purpose for which they were intended.

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Why are you requesting assistance?
Has the patient / individual been hospitalized in the last 12 months?
Has the patient / individual received a formal diagnosis?
Please upload a doctor's evaluation of the patient's / individual's disease or suspected disease.
Upload supported file (Max 15MB)
Itemized expenses of the patient's / individual's care.
Upload supported file (Max 15MB)
Itemized expenses of the patient's / individual's care.
Upload supported file (Max 15MB)
Itemized expenses of the patient's / individual's care.
Upload supported file (Max 15MB)
Does the patient / individual have health insurance?
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508.813.6794

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Hugs For Mito does not provide medical advice, diagnosis or treatment.

Hugs For Mito is a non-profit organization (Tax ID number 81-4919859), and qualifies as a tax-exempt organization under section 501(c)(3) of the IRS.  Hugs For Mito and has been designated as a “public charity” under section 170.

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