How to Apply for Assistance

Thank you for contacting the Doris Daniely Outreach for Breast Reconstruction. Please review our Financial Assistance Policy and Release of Liability then sign, date and have someone witness your signature and return the original copy. In addition, you will need to provide proof of gross income for your household in addition to the following items:

Current check stub (If married, we need check stubs from both)

Three consecutive months of bank statements if self-employed.

Copy of most recent filed tax return

Notarized statement

Copy of Valid Texas Drivers License

Copy of Social Security Card

Return the requested proof of income along with the original signed copy of our Financial Assistance Application (PDF) to

Doris Daniely Outreach for Breast Reconstruction
9386 Hunters Creek, Dallas TX 75243

214-827-8407

Please do not delay in returning all requested information. The Doris Daniely Outreach will not be able to assist you until all information is received.

If you should have any questions, please do not hesitate to contact at 214-827-8407.

services@dorisdanielyoutreach.org

A Not-for-Profit Corporation Benefiting Women in Need