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www.AvamarFoundation.org

Site Design and Maintained by:

www.MDIStudios.com

To Those In need, We are here for you.

 

The Avamar Foundation is ready to serve you!

If you meet the qualifications below, and are in need of financial

help for medications, please follow the steps below.

 Get Assistance 

Qualifications

 

Must be 55 years or older

 

Must reside and receive treatment in our community

 

Must be unable to afford the cost of medications

 

Must Provide low income documentation

(Federal Income Tax, W-2’s, S-1099, etc.)

STEP

1

Download and Print Form

STEP

2

Fill out page 1 and sign/date. 

STEP

3

Take form to your Doctor and have them fill out the bottom of page 2

STEP

4

You or your Doctor can fax the form to 330-372-7480