Financial Assistance Request

Overview
OHHF provides financial aid to assist individuals with childhood-onset heart conditions and their families receiving care from one of our partner hospitals in Missouri or being treated in the St. Louis area. This aid helps address short-term needs and connects individuals and families with community partners for long-term support.

Financial aid requests are considered on a case-by-case basis for individuals with childhood-onset heart conditions and their families.

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.
Your Information






















Tell Us More About Your Heart Condition














If yes, please submit here.

Tell Us About Your Heart Warrior


























If yes, please submit here

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 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