This form is for anyone who has already filled out a Grant Application and been accepted to the program.

NOTE: Every time you travel for treatment, you must complete a Travel Reimbursement form and submit it, along with the corresponding receipts. If you have any questions, please email us.

HOW TO REQUEST REIMBURSEMENT:

1. INITIAL REQUEST: If this is your first time to request reimbursement, please review the complete Reimbursement Policy.

2. RECEIPTS: Snap a picture or scan your itemized receipts.
   NOTE: As of May 6, we are no longer reimbursing for food, but you will need receipts for all other reimbursement items. Upload these in the form.

3. TREATMENT PLAN: Download your After Visit Summary from MyChart or take a picture of documents provided but your doctor. This must include your name and treatment date.

4. DATES: You will need dates of your travel. Travel reimbursement requests must be submitted within 30 days of the travel date. Expenses incurred more than 30 days prior to the date of submission are not eligible for reimbursement.

5. PAYMENT TYPE: We will need your Venmo handle or PayPal email address.

6. REIMBURSEMENT TIMELINE: We do our best to process all requests within 2-3 business days. Payments are usually dispersed within 6-10 business days. If your request has any missing, incorrect, or incomplete information, your reimbursement may take longer. 

7. CONFIRMATION EMAIL: You will receive a confirmation email with all of your submission details.