Request Assistance | Friends Fighting Cystic Fibrosis

Cystic Fibrosis Support Request Form

FFCF is dedicated to supporting children with cystic fibrosis patients (age 17 and younger) and their families residing in North Carolina. By submitting your information through the form below, you grant permission for FFCF to contact medical professionals and social workers, to ensure we can best address your request.

Please note: Requests should receive a response in 7-10 business days.

Eligibility Requirements

My child or dependent has cystic fibrosis.
My child or dependent is living in the United States or receiving treatment at a United States pulmonary clinic that partners with FFCF. Note: If your clinic is not currently a partner, please submit your request, and we will collaborate to onboard your clinic.
I am an adult, aged 18 or older with the authority to make medical decisions for my child or dependent.
I am experiencing financial hardship and am unable to meet my financial obligations.

By submitting your information, you give permission for The Friends Fighting Cystic Fibrosis to contact medical professionals and social workers to better assess and respond to your request.

Cystic Fibrosis Support Request Form

By submitting your information, you give permission for The Friends Fighting Cystic Fibrosis to contact medical professionals and social workers to better assess and respond to your request.

Please note: Requests should receive a response in 7-10 business days.

Type of Request(Required)

Name(Required)

Child's Name(Required)

Email(Required)

Phone(Required)

Address(Required)

Type of Assistance(Required)

Amount Requested(Required)

CF Doctor

Enter name of primary cystic fibrosis doctor here

Social Worker Name

CF Clinic(Required)

Enter your CF Clinic(Required)

Enter your CF clinic. We will reach out to have them onboarded so that we can offer you support.

How did you hear about us?(Required)

Other(Required)

Child’s Date of Birth(Required)

Message(Required)

Please provide as many details as possible on your request to facilitate a timely response.

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