We provide assistance for eligible disabilities. Applicants must exhaust all resources to pay for prosthetics before applying and All prosthetists must be approved by ASPIRE.
All requirements are necessary before an application can be reviewed.
Complete all sections of the attached application in ink.
Fill out all forms completely, including required signatures.
If something does not apply to you, indicate N/A
Before completing application, consult with a clinic/prosthetist for an initial evaluation.
Clinic/prosthetist must complete and sign sections of the application.
All application must include a copy of any explanation of benefits, claims, coverage, awards as well as denials for coverage of prosthetics and related services.
Applicant is considered a minor if under 18 years of age.
Please correctly fill out the application with all the nessesary documentation and mail it to:
128 Mercer Avenue
Hartsdale, NY 10530