Request Help

Please let us know what we can help with and we will try to get back to you as soon as possible to offer our assistance with your specific issue. You will find a list of the ways we may be able to help you, but if you can’t find your query on the list, please tick the last option and provide us with as much detail as possible. We are here for you!

All information provided using the application form is confidential.

Patient's full name:

Caretaker full name:

Patient's phone number:

Caretaker phone:

Patient's e-mail:

Caretaker email:

County:

City:

Diagnostic:

Please provide us with more details regarding the case you are bringing to our attention

How can we help you?

Information and guidance to hospitals in the country

Information and guidance to hospitals abroad

Translation of medical documents

Consultancy regarding the raising of funds necessary for the payment of treatments

Allocation of an SMS number for fundraising

Support to find accommodation options near the hospital

Support to find the medications you need

Solving other needs

Estimated amount required for treatment / surgery:

Destination of funds raised in the SMS campaign

Clinic / hospital name where the patient is accepted:

Country:

City:

Please fill in the fields below to help you find the best accommodation near hospital!

At which hospital will the medical investigations / treatment be performed?

Country:

City:

For how many people do you need accommodation?

Starting with what date you need accommodation?

Until when do you need accommodation?

Detail here if you need special accommodation conditions:

Request Help

General information

Data required for the allocation of an SMS fundraising number

Application to find accommodation options near the hospital

Please fill in the fields below to help you find the best accommodation near hospital!