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Children's Reconstructive Surgery | Apply for Help Fresh Start

Apply For Help


Every day, our mission at Fresh Start comes to life and we change the lives of disadvantaged infants, children and teens with physical & cosmetic deformities caused by birth defects, accidents, disease or abuse through the gift of reconstructive and plastic surgery. Whether it’s a cleft lip palate or scar created by abuse or burns, we can help perform these surgeries and many more. Every child receives the highest quality medical care, regardless of the family’s ability to pay. Accepting applications from across the US, families never receive a bill for treatment.

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    Applicant Information

    Thank you for your interest in applying to Fresh Start. Please indicate if you were referred by:

    Name *

    Applicant's Address *

    If not in the US, does the patient and parent have passport?

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    Parent/Guardian Information

    Parent/Guardian Name *


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    Description of Condition

    The following lists the surgical procedures perlabeled at Fresh Start. Please select the type of surgery or treatment needed:

    Physician's Name

    Physician's Phone

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    Household Information

    Please list names of patient & family members. Include the income source/type of employment for each family member, their age, relationship to the applciant, their gross yearly income, and if he/she is a dependent:

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    Image / Documents

    Please attach: medical records, photographs, insurance information/denial letter. Applications without photographs cannot be processed. Please call (760) 448-2023 for more information. Please avoid blurry images and make sure these images are legible.

    Signature and Date

    I declare under the penalty of perjury that the foregoing is a true and accurate statement as to the availability of any insurance or state funded reimbursements for the surgery requested of Fresh Start Surgical Gift, Inc.

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