You Have Us

In times like these, it can be even more difficult to know where to turn for help. It can be overwhelming to figure out how to meet even our most basic human needs.

Patients of Chase Brexton Health Care, you are not alone. Chase Brexton’s Social Work and Outreach team is here to help. We offer the resources, support, and knowledge to assist you and to navigate these troubled waters with you.

For assistance, please complete the form below and a member of our Social Work and Outreach team will be in touch with you soon.

Please understand, this fund is for patients of Chase Brexton Health Care only.

*Please note: Chase Brexton staff are not eligible for this assistance.

Question Title

* 1. Are you a patient of Chase Brexton Health Care?

Yes

Question Title

* 2. Please provide the following contact information:

Name *

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date of Birth

Email Address *

Phone Number *

Question Title

* 3. Please let us know the assistance you are seeking. We will do our best to help you.

Grocery/food assistance

Utility assistance

Rent/mortgage assistance

Other living expenses related to COVID-19 quarantine (please explain below)

Please let us know what led you to need the above assistance.

Question Title

* 4. Do you need any assistance with the following medical needs?

HIV testing

PrEP/PEP information and guidance

Getting in to see an infectious disease provider for treatment of HIV

None of these

Question Title

* 5. Would you like to receive our patient e-newsletters? You can opt out at anytime.

Yes

When you click the submit button below, this information will be immediately sent to our Social Work and Outreach team. Because of the COVID-19 pandemic, please know that our service hours have changed to 9AM to 5PM Monday through Friday.

We will be in touch with you soon. In the meantime, stay home and stay well.