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Applications for support will be
considered from couples
and individuals who have a confirmed diagnosis of
infertility by the Heartland Fertility & Gynecology Clinic,
have been referred to the Fund, and who demonstrate
adequate need for financial assistance. All applications
will be considered on a relative priority basis. Request a
Giving Hope Fertility Assistance Fund
application from your
Heartland Fertility & Gynecology Clinic physician
or print your own.
(if you can not open these files download the safe
.pdf reader)
(you need all three forms)
Application for Funding
Physician's Referral Form
Release of Information Form
Heartland Fertility & Gynecology Clinic
701-1661 Portage Ave., Winnipeg, Manitoba
Phone (204) 779-8888 |
