Submitting a Me Fine Referral
Me Fine serves as an emergency safety net for the families of children in active treatment for a medical crisis. We provide assistance to families experiencing financial distress due to their child's medical crisis.
Please consider the following questions to determine whether this is an appropriate referral.
IS THE PATIENT CURRENTLY IN A MEDICAL CRISIS?
Me Fine considers a medical crisis to be a new diagnosis or sudden change in medical condition that dramatically impacts the family system. Patients must be in active treatment, such as inpatient stays or multiple clinic visits per week/month. For chronic conditions, we look for a significant change in condition, such that the "new normal" that families find post-diagnosis is no longer stable. We do consider hospice to be an active treatment choice.
IS THIS FINANCIAL NEED DUE TO A CHILD’S TREATMENT?
Me Fine understands that families can experience a wide range of financial stressors. While we certainly empathize with these various situations, our mission is to assist families with financial distress that is directly caused by and related to their child's active treatment for a medical crisis.
Google Form Option
Please complete this form to submit a referral. Of note, this form is embedded on this page. You may need to scroll within the frame in order to see and submit all fields. A “Next” button appears at the bottom of each page to continue.
*Some organizations are blocked from using Google Forms. If a form does not appear below, please use the basic referral form we’ve included at the bottom of this page.
Basic Form Option
If you are encountering issues using our Google Form (that appears above), please complete this form instead to begin the process of submitting a referral. Once we have received your application, we may need to reach out to you for additional information.