Spiritus Project - Request Assistance

IMPROVING THE LIVES OF ADULT CYSTIC FIBROSIS PATIENTS

Date of birth *

How did you hear about Spiritus Project? *

Address - Street *

CF Clinic: *

Message: *

Address - State *

CF Doctor: *

Address - City *

REQUEST ASSISTANCE

To request assistance, please complete the simple form below. We prefer to make payments directly to the provider, so we'll need copies of statements and possibly other documentation. We do try to keep things simple and be responsive to patient requests, usually responding and providing a solution within 72 hours from the time we receive the required documentation.

Please note that Spiritus Project is staffed by an all-volunteer team Monday thru Thursday. We are closed Friday thru Sunday, all banking holidays and periodically for staff vacations. Thank you for your patience!

Please note that Spiritus Project is currently focused on assisting adult (18 and older) cystic fibrosis patients who receive their primary treatment via the UNC Adult Cystic Fibrosis Center. Submitting your information grants your permission for Spiritus Project, if needed, to contact medical professionals and social workers to determine how best to respond to your request.

Last Name: *

Email: *

Amount requested: *

Type of Assistance *

First Name: *

Address - Zip *

Phone *

Subject: *