Healthcare Provider Verification for Current Hospital Stay

Healthcare Provider Verification Form

This form is provided to serve as the verification piece of hospital and/or NICU stays.  It is to be completed by the patient's doctor, social worker, or nurse, or other healthcare provider working with the patient(s).  We do not require this form, but do require some type of verification.  You can upload your verification at the bottom of this page. 

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If you prefer, you can download one of the attached templates of a letter for verification.

Foundation Verification Letter for Pregnancy

Foundation Verification Letter for NICU