Send support documents for bill pay to ksavage@meganswings.org or Fax to (909) 942-6808.

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* 1. Type of Financial Aid Requesting?

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* 2. If Asking for Help Paying a Bill, Can You Send A Copy of The Bill By Email or Fax?

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* 3. Provide brief explanation of patient situation and financial hardship:

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* 4. Patient Information:

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* 5. Estimated Monthly Family Income and Assets:

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* 6. Estimated Monthly Immediate Family Expenses:

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* 7. Patient's Medical Information: (Should Be Completed By The Patient's Doctor, Nurse, or Medical Social Worker):

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* 8. Include additional explanation or comments below. Megan's Wings will review information & reply to person submitting request within 24-48 hrs. Funds are limited and based on availability. All information provided is strictly confidential and used to help determine aid by Megan's Wings. Please email support documents for bill pay request to ksavage@meganswings.org or fax to (909) 942-6808.

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