We do our very best to accommodate the needs of each child with a craniofacial difference who seeks our help. To discuss assistance possibilities with us, first please complete the form on our Family Support page, which you will find on the Our Work drop-down menu, or you can click on the link below. If we determine that we can assist you or your child, we will help you submit the appropriate financial-assistance applications.
Please fill out the application entirely, sign the photo release and consent release at the end of the document (last two pages), and include the following items:
A recent photograph of the patient – photograph will not be returned
A copy of any medical history/records on the patient
The name and contact information for the attending plastic surgeon and the primary care physician/pediatrician
A letter from the attending plastic surgeon, confirming appointment date, surgical treatment plan/procedures and estimated length of stay
A copy of your most recent IRS tax return, if you are applying from within the United States
A copy of your most recent check stub
You must complete and return the Application for Assistance 4 to 6 weeks in advance of the date of travel. Medical emergencies will be the only exception, and declaration of emergency must come in writing from the attending plastic surgeon and/or the primary care physician/pediatrician.
After the operation, you will be required to provide another set of photos of the patient.
For assistance in completing your application, or to be matched with a craniofacial plastic surgeon and/or craniofacial center,
Please call us at +1 972 566 6669 or Toll-free in the U.S. at 800 533 3315.