Please email additional paperwork that may be helpful (insurance denial letter, letter of medical necessity, etc) to and reference your application.

You can also complete our Application here or download, complete and email to

7 thoughts on “Application

  1. Our daughter, Bekah, was born with a partially paralyzed diaphragm. She is dependent on a ventilator and have been home less than a week from the hospital. She has a tracheostomy and g-tube. Our insurance covers 100 suction catheters per month. This means that we have to reuse catheters. Because her diaphragm is partially paralyzed, she doesn’t ventilate well in the right lung. This makes her susceptible to secondary infections and pneumonia. Reusing suction catheters puts her at risk for severe infection. Both my husband and I are on fixed incomes and are looking to supplement her catheter supply. Please let me know if you can help or if you know where help can be found. Thank you.


  2. I was directed to your page through a friend at childrens. I have a little boy who is on elecare. Insurance refuses to cover it. And wic wont cover it no matter how much a beg them. He has a gtube epilepsy lung disease gerd cerebral palsy and a whole list of other complications. We have to buy a can every day and its getting beyond difficult to come up with the money and I dont know where else to turn too. Every phone call I make gets an immediate NO.

  3. Hi my 3 year old son just got a g-tube we r in need of an entralite
    infinity pump. I do have a small rifton pacer gait trainer I can basicly trade for it it has all the iteams including parent handle and if u have a pump I am on a few sites for medical exchange I can try an take up a collection as well and see if I can get anything for u
    Thanku for ur time

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