Request Assistance and Information

Request Assistance

ATDN or The Network is located in New York City, where we provide direct services to people with HIV and HIV/Hepatitis co-infection. We also have a national assistance program called The Access Project. We are once again in the process of updating state by state information, adding new resource sections. Use the Request Assistance form or leave a message at 1-800-734-7104, extension 22 if you are calling from outside New York City. Using the form Request Assistance will always get you a quicker response.

If you live in New York City and have HIV or need to get tested just call 1-800-734-7104 between 9:30 to 5:30 Monday through Friday.

Please Fill out this Form

Use this form to request specifics about your insurance options, Medicaid, Medicare, Patient Assistance Programs, AIDS Drug Assistance Programs, State Insurance Pools, Treatments, AIDS Housing and other needs.

Answer all the question as best as you can

Name

E-mail (required or we can't respond!)

Zip Code

State

How did you find us?

Medical History

Your Needs

Any Income or Assets (disability income, bank savings, home ownership, employment, etc.)

Any Commercial Insurance ?

Have co-pays or deductibles?

Have you applied for Medicaid or Medicare?

Gender, Race, Age

Comments

The Network is a 501(c)(3) non-profit founded in 1988
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Last modified: 08/25/2009
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