Application Checklist

The more information you can give us using the online application, the more quickly we can process your request. We will collect any missing information during the phone interview. This is what we need:

Applicant Information. Name, address, email, phone number(s).
Personal Representative Information. Contact information for the person completing the form if not the patient.
Care Provider Information. Name, phone number, and dates of service of the Christian Science nurse or facility.
Forms. Before starting the application, please print and complete these two forms:

Print & Complete Financial Worksheet

Print & Sign Standard Authorization Form

Documentation. Federal tax form 1040 (first two pages), Power of Attorney (if applicable), CS nursing and practitioner invoices (may be submitted later).

All information you provide will be kept in strict confidence.