Emergency Assistance Fund
About the Process
To assist in the review and validation of applications for aid, we only accept requests from providers at Hemophilia Treatment Centers or at other institutions where you receive care to treat your bleeding disorder. Healthcare providers typically know the candidates, understand their current financial state, and are better suited to determine the severity of the need for emergency funds.
Follow-up calls may be necessary when information is missing or to discuss the specific case when the need is unclear. Individual requests without HTC support may also be considered.
- Applicant has a bleeding disorder and/or lives in the same household of the person with a bleeding disorder.
- Applicant lives in one of the six New England states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, or Vermont.
- The applicant has not applied within the last 365 days.
- The applicant is experiencing a hardship directly resulting from or directly affecting the bleeding disorder.
- The request is related to food, housing, utilities, or transportation.
How To Start An Application
- The applicant identifies the need (i.e. electric bill, mortgage, food, etc) and collects the appropriate documentation.
- The applicant contacts their healthcare provider team.
- The applicant asks their healthcare provider to fill out the below form on this page.
- Once an application is submitted by a healthcare provider, a decision is made within 5 days.
Application for Emergency Financial Assistance
This form should only be completed by a healthcare professional. If you are a patient seeking financial assistance, please ask your nurse, doctor or social worker to submit a request on your behalf.