Putting family over finance
A charity organization based in
Middlebury Center, PA
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 firstname.lastname@example.org.
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!