Your Fundraiser

In two easy steps

  • 1

    Bill Details

  • 2

    Fundraiser Info

Please select the name of the facility as it appears in Google Maps

You can upload a document (PDF), a photo of the bill, or an Explaination of Benefits from your insurer

You can add up the total costs of estimates or bills received

This will help us recommend experienced care provided to other patients

We request that you omit sensitives data from bills, including your name, address and other personal information. By submitting your mediacal records, you are choosing to publicly share your protected health information, which is otherwise protected from disclosure by you health care provider under the Health insurance Probability and Accountability Act.

This is your out-of-pocket expense that will be paid directly to the provider

This picture will be used in your fundraiser. You can preview it before starting your fundraiser.

Why are you fundraising? The more detail the better to attract funders

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