Dear Client-
Thank you for contacting the Gateway Area Chapter of the National Multiple Sclerosis Society. Enclosed is a set of the financial assistance forms that you recently requested.
- Please complete and sign the Financial Assistance Application, and return it in the enclosed pre-paid envelope. The information will help determine the amount of financial assistance we can provide and will be kept confidential.
- Please have your physician complete and verify the Multiple Sclerosis Diagnosis Confirmation Form and return it to our office.
- Should you need assistance with equipment, we require a prescription on a prescription pad or letterhead from a physician for the requested equipment.
To apply to the Gateway Area Chapter Financial Assistance Program, complete the forms above.
If you have any questions, please contact us at 1-800-344-4867 or 314-781-9020.
Sincerely,
Gateway Area Chapter Services Department