Putting family over finance

A charity organization based in

Middlebury Center, PA

Services

Before the Humble Bumble Project can help you with your out-of-pocket cancer-related expenses, we need a couple of things from you first. Upon completion of these forms, please send them both as attachments to info@humblebumbleproject.com.

Referring Healthcare Professional Consent Form

This form says that you consent to giving us your medical history and referral form.

consent form
 

Patient Referral Form

This form contains your medical history, your diagnosis, and a referral from your doctor. This is the most crucial part of your application. Without it, we cannot offer assistance for your cancer-related expenses.  

 

Don't worry, your medical history is safe with us. 

We are HIPAA compliant! 

patient referral form
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2019 The Humble Bumble Project is a registered 501(c)(3) public charity. 

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