Uber Eats/Instacart Gift Card Request Form GUIDELINES FOR FAMILIES SEEKING GIFT CARDSRequests for gift cards are accepted from families in the Houston area who have previously applied for and received financial assistance from Addi’s Faith Foundation. To apply for financial assistance click HERE. Gift cards are meant to support families that are in the hospital for treatment, so please only apply during admission or when an admission is scheduled. Requests may be submitted once per month. Gift cards are distributed weekly. Please allow 1-3 days for an electronic gift card to be received via email. Date:* Name of person completing this form:*FirstLast Relationship to patient:* Child’s name:*FirstLast Email address:* Hospital name:* Admission date:* Please select either “Uber Eats” or “Instacart”*Uber EatsInstacart Have you previously applied and received financial assistance from Addi’s Faith Foundation?(1)*YesNo reCAPTCHASubmitReset
