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Do You Qualify?

Fill in the Form or call us directly at (+1) 661-404-4748

Call us today at (+1) 661.404.4748

or fill out and submit our application form.

 

It only takes 3 easy steps:

  1. Download and fill out the form located at the bottom of the page. Choose the language of your preference.
  2. Carefully follow the instructions and fill it out.
  3. Submit the application.

Please be sure to send copies; keep the original for your records, the original documents will not be accepted. If you have any questions, please contact our office Monday through Friday from 9:00 A.M. at 5:30 P.M. and ask to speak with Abby Hannah, Executive Assistant. Thank you!

 

(+1) 661 404-4748

administration@csffoundation.org

3811 Mount Vernon Ave., Bakersfield, CA 93306

Application Downloads

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Returning Your Application

Follow These Steps To Return Your Application

Step 1) Download & Print Out The Form
Step 2 ) Fill out The Form
Step 3 ) Scan and upload the complete form
Or you can fax the application to 661.327.7255

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Last Name
Your Email
Please upload your application here.
Make sure you have filled out and scanned your application before proceeding.
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Once you have submitted your application, we will review it within 24-48 hours. Please contact us at (+1)661.404.4748 to verify the status of your application.

Criteria to qualify:

  • No medical health insurance.
  • Low income. Federal Poverty Level (FPL) per person is $12,760.00 per year; per couple it’s $17,240.00. Add $4,480.00 per additional member in the household.

During 2020, CSF Medical Non-Profit Foundation will be focusing on Health Education, Prevention, and Early Detection of illnesses. CSF Foundation will utilize donations to pay the total cost for diagnostic exams of low-income uninsured individuals.

 

(If any of the patients who had exams through us is in need of a surgery, CSF Foundation will guide them about the possible options and through the process with CSF Surgery, our founder organization, which offers reduce cost surgical procedures for uninsured individuals.)

Requirements:

  1. Copy of patients Identification.
  2. Must have a medical diagnosis from a family doctor or specialist. If the patient does not have one, we recommend calling CSF Foundation to receive specialized information at (661) 404-4748.
  3. Employment verification for all who work in the household
  4. Last 3 months of check stubs for everyone who works in the household.
  5. Most recent rent receipts
  6. Utility receipt (showing residency address).
  7. Checking and Saving bank account statements for the last 3 months. If you do not have any bank accounts, please write a note stating so. Make sure to write your name, date, and sign the document.
  8. Most recent tax returns for all the tax payers of the household .

RIGHTS & RESPONSIBILITIES

  1. You have rights and responsibilities when you apply for a reduce cost, no cost or financial assistance for medical exams and surgical services with CSF Foundation. Your most important right is to be treated with equality regardless of race, national origin, politic views, religion, gender, age, disability, sexual orientation, and or immigration status.
  2. You can receive assistance with your application or financial documents.
  3. You will be treated with courtesy, respect, and consideration.
  4. To apply does not guarantee approval for financial assistance.
  5. CSF Foundations committee will determine eligibility and amount of financial assistance provided. 
  6. You could qualify for total assistance for diagnostic exams and examinations according to what the committee approves and advices. You could qualify for partial or total payment for surgery, if needed, according to what the committee approves and advices.
  7. For surgeries, we will only consider applicants with an established surgical diagnostic previously evaluated by a CSF physician.
  8. If the applicant has been approved for CSF Foundation financial assistance: 
    1. For medical examinations: the completion of medical examination must take place in the consecutive 3 months. 
    2. For surgical procedures: the completion of the surgery will depend on the assessment of the specialist, and/or in some cases the anesthesiologist.
  9. In case of approval and in need of surgery, if the applicant presents serious medical illness, surgery will be considered once those pre-existing conditions are stabilized and suitable for surgery.
  10. All applicants who live outside Bakersfield, CA must be willing to travel to Bakersfield, CA to receive their evaluation, examination or surgical services if applicable.
  11. CSF Medical Non-Profit Foundation has the right to use any medical institution to perform the medical examination or surgery. CSF Foundation pays the institutions directly. Under no circumstances does the applicant received any monetary amount.
  12. All applicants must participate in an interview either in person or by the phone conducted by a CSF Foundation staff.
  13. All approved applicants will be invited to give a testimony of how CSF Foundation has improved their health. The testimony can be written or filmed and will be used for marketing campaigns and as evidence of our work to donors and sponsors.  
  14. All approved funds are available to approved patients for no longer than 3 months from the initial approval date. If for whatever reason the patient does not use the allocated funds within the 3-month period, he or she must reapply to CSF Foundation.  
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