Meal Delivery Gift Card Request Form

GUIDELINES FOR FAMILIES SEEKING A MEAL DELIVERY GIFT CARDRequests for a meal delivery gift card 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. Please allow 1-3 days for an electronic gift card to be received via email.

Date:*

Name of person completing this form:*

First

Last

Relationship to patient:*

Child’s name:*

First

Last

Email address:*

Hospital name:*

Admission date:*

Have you previously applied and received financial assistance from Addi’s Faith Foundation?*

Yes

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