2. Lung Health Expense Receipts
Attach a copy of the lung health related receipt(s) you are requesting financial reimbursement for.
3. Support Documentation
People with lung disease and/or primary care givers applying for Caring Breath’s will require a referral form from a health care provider.
Medical: Health Care Provider Referral Form
Upload a copy of the documentation from a health care provider stating that you or someone you are caring for requires the above request. Your health care provider can also fill out the fillable PDF template below and email it to us directly at email@example.com. Some examples of health care providers that can provide a letter of support includes but is not limited to; Doctors, Nurse Practitioners, Nurses, Social workers, Physiotherapists, Pulmonary Rehabilitation Exercise Therapists, Certified Respiratory Educators, Respiratory Therapists, Pharmacists etc.
Download the Health Care Provider Referral Form
4. Income Verification
What is your net disposable income? (monthly income after taxes) Choose range that applies to you.
5. Other Financial Support
Select any other organizations you have received financial support from to help cover related costs.
Optional: Other Information
You may use this field to provide any other information you feel is relevant or important to your application.
To find out more visit Caringbreaths.ca or If you have any questions about our Caring Breaths program, please email firstname.lastname@example.org