GPF Assistance Requirements

Beneficiaries must live (or be receiving active treatments) within the immediate Dallas/Fort Worth Metroplex. We exist to help individuals that are battling cancer and other acute illnesses. We are not able to help individuals with injuries due to accidents, or chronic conditions and diseases.

After you submit this form, please check your email. You will be immediately emailed a link to fill out one more form.

We cannot review your request until you have completed and submitted the second form, which can be found here.

If you have any questions, please email:

Contact Info for the Person/Patient in Need

Name of the Person/Patient in Need(Required)
Is Person/Patient in Need:(Required)
Address of the Person/Patient in Need:(Required)

YOUR INFORMATION (if not the patient)

(if you are the patient, type SELF)