Request Assistance


To qualify for assistance, you must be a resident of either Cameron, Willacy or Hidalgo counties in the lower Rio Grande Valley. The information you submit is confidential and will be sent to our board for review. If you have any questions you can always reach us by phone at (956) 495-9884.

Name *
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Doctor's Address *
Doctor's Address
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Doctor's Phone
Please write a brief description and history of the diagnosis: