Recommend an Adult

Know of an individual with a disability or life-threatening illness who is in need of financial assistance to help cover medical expenses? Please contact us with the full story and details of the individuals`s condition and current financial situation. She/He can be of any age and must be residing in South Africa. If you do not have the correct contact details of the person, the diagnosis, and/or other requested information – kindly forward the link to the individual, parent or legal guardian. This form MUST be completed with all relevant information. Thank you in advance.

Individual`s first name and surname.
Age and medical diagnosis of the individual.
Where the individual lives.
The individual`s story. Please include as much information as possible to speed up the application process.
Include Medical Aid status and medical expenses that are not covered.
Name of the page or the URL i.e
Individual`s contact details.
Individual`s email address.
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