I Don't Even KnowWhere To Start That's ok. We're Here to Help. Not sure where to even start? You shouldn’t have to know what help you need to get help. Just tell us what you’re dealing with and we’ll get you to the right kind of support. Help Request What is your relationship to the patient?(Required) I am the patient I am the patient's family member or caregiver Other If "Other", please describe your relationship to the patient. Your Name(Required) First Last Your Email(Required) Your Phone NumberHow would you prefer we contact you to follow up? Phone Email Either Patient's First Name(Required) First Last Your Location City or Town AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Patient Location(Required) City or Town AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State What do you need help with? (Please check all that apply) Health Insurance Healthcare Costs/Bills Healthcare Services Other I don't know Please describe the situation.(Required)Would paying for an advocate be a financial hardship for you?(Required) Yes (I cannot pay for an advocate) No (I can pay for an advocate) Not sure (I can pay something, but may need some help paying for an advocate) Most advocates charge for their time and expertise. Sometimes, advocates do work for free or a reduced fee. We will post your request to our network of qualified advocates. If an advocate feels they may be able to help you, they will reach out to you directly. We hope to connect you with the help you need but we cannot guarantee anyone will respond. Please acknowledge and consent below.(Required) I agree. Please share my request for help with your advocates. I do not agree. Please do not share my request for help with your advocates. By clicking SUBMIT: You acknowledge that we may not be able to match you to an advocate, but we’ll do our best. You confirm that you understand that advocates charge for their time. You confirm that you understand that you may, or may not, be contacted by someone who will help you. You give us permission to share your request with our advocate network, which may include listing it for members of the Alliance of Professional Health Advocates. *Any information you provide to us will remain confidential except to potential advocates. Either we or an advocate will contact you through the email address or phone number you provide. See our privacy policy.
