Application Form

Please print out and complete this form and forward the printed version to the Charity’s address given on the last page. Please make sure that you enclose a clinic letter with your application.  The clinic letter should be the result of a private consultation held at a private hospital and will give details of the procedure required.

What Happens Next?

We will obtain a price from the hospital, thus establishing the total likely liability to the Charity, were we to fund.  Then a visiting Trustee will make a mutually convenient appointment to discuss the application with you at home.  The Trustee will submit a report, which will enable the board to make an informed decision as to whether we help you.

Local Private Hospitals

Below are web page links to some of the organisations that St. Saviour’s Medical Charity has assisted.