Apply for Help

Apply for Endometriosis Excision Surgery Financial Help

Living with endometriosis can be challenging, both physically and financially. At Endo Excision for All, we believe that every person deserves access to quality healthcare and effective treatment options, regardless of their financial situation.

Our mission is to help individuals with endometriosis access the medical coverage they need for proper diagnosis, treatment, and ongoing care. By filling out this application, you're taking an important step towards potentially receiving financial assistance for your endometriosis-related medical expenses.

Before you begin:

Please ensure you have information about your medical history and current endometriosis symptoms ready.
Be as detailed and accurate as possible in your responses.
All information provided will be kept strictly confidential and used solely for the purpose of assessing your eligibility for medical coverage assistance.

Remember, you're not alone in this journey. We're here to support you every step of the way.

Please keep in mind that we carefully review and verify all financial information before offering any grant support.

Name

First Name (required)

Last Name (required)

Email (required)

Phone

City, State of Where You Live (required)

If you are outside of the US, please provide city/country.

Have you been officially diagnosed with endometriosis? (required)

If yes, when were you diagnosed and how?

Past surgeries related to endometriosis (if any):

What symptoms do you suffer from and how long have you been experiencing these symptoms? (required)

How do these symptoms impact your daily life?

Have you sought treatment for endometriosis before? (required)

If yes, please describe the treatments you have tried:

Have you already scheduled a consultation with an endometriosis excision surgeon? (required)

Do you have a surgery date scheduled? If so, when? If your date is uncertain, on hold, or waiting on something, tell us anything you'd like us to know about it.

Do you have a cost-estimate? If so, please breakdown by surgeon's fee, scheduling fee, hospital estimate, etc. and clarify timeline of when costs are due given your surgery date.

If yes, please let us know the doctor and practice you are considering:

Do you currently have health insurance? (required)

Please tell us your insurance company + plan. Specify HMO, EPO, PPO, or Medicaid. (required)

Failure to provide us your insurance plan details in this form (EPO, HMO, PPO, Medicaid) delays the process.

What is your annual household income? (required)

We will ask for proof of income and run reports, so be truthful.

Please describe why you are seeking financial assistance from Endo Excision for All: (required)

Thank you for answering the questions above. Please share anything additional about your story you'd like us to know below. (required)

How did you hear about us?

Important Information Before You Apply

Endo Excision For All provides financial assistance to help offset the cost of endometriosis excision surgery. Grant awards are determined on an individual basis and are based on available funding, demonstrated financial need, and the number of qualified applicants.

While applicants may request assistance for the full cost of surgery, grant awards are most often intended to provide partial financial support that helps get patients into the OR. In some cases, when funding allows, we may be able to cover a larger portion—or even the full cost—of surgery, but this is not guaranteed. Submitting an application does not guarantee funding or that the full cost of surgery will be covered.

Every funding decision is made in good faith with the goal of helping as many patients as possible with the resources available. Grant awards vary based on available funds and the unique circumstances of each applicant.

Applicant Conduct & Respectful Communication

We recognize that financial hardship and the inability to access surgery can be deeply emotional. We are committed to treating every applicant with compassion, dignity, and respect, and we ask that the same courtesy be extended to our Board members, staff, volunteers, donors, and partners.

Harassment, threats, abusive language, intimidation, or knowingly false or defamatory statements directed toward Endo Excision For All or its representatives will not be tolerated. Such conduct may result in disqualification from current and future funding opportunities. Endo Excision For All reserves the right to pursue any legal remedies available under applicable law in response to false, defamatory, or malicious statements.

I acknowledge that I have read and understand the information above, including that grant awards are based on available funding and may provide only partial financial assistance, and that I agree to communicate respectfully throughout the application process.