[Access to Care]

Request Assistance

E-Access to Care, a program of Housing Works and ATDN, is part of Housing Works' Access to Care Department. We provide direct services to people with HIV and HIV/Hepatitis co-infection. That includes people at risk for HIV as well as hepatitis. We also have a national assistance program called The Access Project. Use the Request Assistance form or leave a message at 1-800-734-7104 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 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
         
       
 
 
 
 

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Last modified: 02/26/2010
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