31640 U.S. Hwy 19 N. Suite #2 Palm Harbor, FL 34684
(727) 781-HERO (4376)
Healing Heroes Program provides financial assistance and arrangements for treatments through its nationwide network of providers.
The needed treatment or therapy must be the result of an illness or injury incurred or aggravated in the line of duty in Iraq or Afghanistan after September 11, 2001.
You must provide Healing Heroes Network with a copy of your DD Form-214 and/or your last duty orders before we can complete your application process. You can upload them now for faster processing.
* Required Information
By submitting this form, I confirm that the above information is correct. I understand that completion of this form does not guarantee that the services requested will be provided.
I hereby give Healing Heroes Network permission to leave messages on my phone and to access my medical records, in accordance with HIPAA. I understand that Healing Heroes Network will not use my records for any other purpose, or give my information to another party.
by phone: (727) 781-HERO (4376) - Local
by e-mail: firstname.lastname@example.org
or fill in the form on our contact page