Apply For Help:

We are here to support brain tumor patients and caregivers in the Triad area. To obtain support from our organization, an application for financial assistance must be completed. All applications are subject to review by TriadBeHeadStrong. A diagnosis must be verified with the attending physician.

In the link below you will find our application form. Each of the following steps must be completed before we will consider you as a candidate.

1. Complete the registration form

2. Read and complete the HIPAA authorization form

3. Read and retain our Privacy Statement for your records

4. Email to triadbeheadstrong2015@gmail.com OR Mail the completed Registration form and HIPAA authorization to:

   TriadBeHeadStrong
   PO Box 8076
   Greensboro, NC 27419

Upon verification with your physician, a representative from TriadbeHeadStrong will be in contact with you to discuss our available services. All services are subject to availability and quantities are limited.

If you have further questions, feel free to contact us directly at (336) 308-2255 and we will do our best to assist you.