Financial Assistance Request

Overview & Contact Information

OHHF offers financial assistance to individuals with childhood-onset heart conditions and their families who are either receiving care at one of our partner hospitals in Missouri or who live in the St. Louis area and are being treated elsewhere. This support helps meet short-term needs and connects families with community partners for long-term assistance.

Financial aid requests are considered on a case-by-case basis.

Note that submission of this application does not guarantee fulfillment of the request. Please be assured that all your information is kept confidential per our privacy policy. OHHF values your privacy and does not share or sell your information to third parties without your written consent. We use the information you provide to improve our services and better understand your needs and the needs of the heart community.
























  • Start typing in your address below--spell out street names ("Street" instead of "St" or "Avenue" instead of "Ave").
  • Click your full address when it pops up in the search. Confirm that it's correct and add any apartment or unit info in the "Street 2" box.
  • If your address does not come up in search, select each box individually to manually type it in.






Tell Us More About Your Heart Condition











If yes, please submit here.

Wonderful! Your Care Manager will make a formal referral for you so you can be connected to a peer mentor.
Please choose the category or categories that fit you. You can pick more than one.

After you choose, you can opt in to see more specific conditions. If you're not sure about a category, you can check the box to see the choices on the next page then uncheck on this page if it doesn't fit.

Your information is private and safe.


Tell Us About Your Child
























If yes, please submit here
Please choose the category or categories that fit your family. You can pick more than one. After you choose, we'll show you more specific diagnoses. If you're not sure about a category, you can check the box it to see the choices on the next page then uncheck it if it doesn't fit. Your answers help us connect you with the right care and support. Your information is private and safe.


Heart Conditions










NICU-Related Conditions

Genetic Conditions

Neurodevelopmental & Neurodivergent Conditions





Mental Health Conditions


















Tell Us About Your Healthcare Coverage





Tell Us About Your Household









Help Us Understand Your Needs


All assistance payments will be issued directly to the vendor. After OHHF approval, allow 7-14 days for payment processing and mailing.

Any bill submitted below must be a complete statement and include the following:
- company name
- your name
- account number
- amount owed
- how to pay the balance

Review may be delayed if all information is not submitted with the initial request.






































Tell us if you are facing any of these Barriers

Please answer the following questions as honestly as possible.









Tell us about your financial health

The information provided on this page will help us determine the amount of financial assistance OHHF can provide toward your request. Please answer the following questions honestly by selecting the statement that best represents your needs. 


Our team will reach out after we review your intake form to talk about options.


Definitions:
* Basic needs include food, housing, and transportation.
** Expendable income might mean you can regularly buy coffee at a shop, buy new clothes, go to the movies, etc.











Share References

Please provide two references. These can include your social worker, nurse, physician, or other healthcare provider.










Consent to Participate in Community Outreach Program

By completing and submitting this form, I understand and agree to the following:

1. Collection of Information
  • Ollie Hinkle Heart Foundation (OHHF) is collecting the personal information I provide for the purpose of offering services, resources, and communications related to its mission.
2. Use of Information
  • My information may be used by OHHF staff to assess needs, connect me with programs, provide updates, and improve services.
  • De-identified and aggregated data may be used for reporting, evaluation, and advocacy purposes.
3. Sharing of Information
  • OHHF will not sell or share my personal information with third parties for marketing purposes.
  • OHHF may share my information with trusted partners or providers only when necessary to deliver requested services or as required by law.
4. Confidentiality & Security
  • OHHF will take reasonable steps to protect my information and maintain confidentiality.
  • Despite these safeguards, I understand that no system of transmitting or storing data can be guaranteed 100% secure.
5. Voluntary Consent
  • Providing my information is voluntary. I may choose not to share certain information, but this may limit the services or resources available to me.
  • I may request to update or withdraw my information at any time by contacting OHHF at publicrelations@theohhf.org. 
6. Digital Media Consent
  • I understand Ollie Hinkle Heart Foundation may use any photograph, video or other digital media (“Photos”) taken during this event, in any and all of its publications, including print or web-based publications
7. Consent Statement
  • By submitting this form, I confirm that I have read, understood, and voluntarily consent to the collection, use, and sharing of my information as described above.
By typing your name and initials, you are acknowledging and agreeing to the above regarding your request.
  • I have reviewed OHHF’s website privacy policy and agree with all terms.
  • I have reviewed OHHF’s client rights and responsibility policy and agree with all terms.
  • I understand that OHHF has not and will not provide me with medical, legal, or tax advice.
  • I will complete a client satisfaction survey if approved for financial aid services.





I hereby authorize the name/s listed below to discuss and participate in coordinating my services through the Community Outreach Program. I understand that if a name is not listed below, Ollie Hinkle Heart Foundation cannot release any information.




Contact Information