Healthcare Provider Verification for Current Hospital Stay

Healthcare providers: Please fill out the form below or use the templates as a letter and email to

Download Foundation Verification Letter for Pregnancy

Download Foundation Verification Letter for NICU

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Your Name*
Hospital Address*
Reason for Application*

MM slash DD slash YYYY
Max. file size: 50 MB.
I agree that by marking yes, I am attesting that the information in this application is correct to the best of my knowledge.*
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