Assistance

Help is only a phone call away…The Tri-State MS Association!

812-423-5943 or toll-free 1-866-514-4312

We are blessed in this Tri-State area to have a local association providing services to people living with M.S. and their family members. We want you to take advantage of those services and to help us spread the word to others living with or affected by this disease.

SERVICE AREA MAP

Some of the services we provide include:

Local Support Groups- We currently have 5 local support groups who meet monthly.
M.S. Ambassador- People living with M.S. who are willing to meet with or talk by phone with newly diagnosed individuals. MS Nurse Specialist-Susan Reynolds, RN. has had M.S. for many years.
Educational Programs- Lunch N Learns, MS Chair Yoga, Pharmaceutical dinners
Newsletters- Provide valuable information about upcoming programs and events. Disease management articles from Susan Reynolds, RN.
Social Events- It is important to build relationships with other people who can truly understand what it means to live with M.S.
Fundraising Events- All money raised by the Tri-State Multiple Sclerosis Association stays local. These dollars help in our efforts to offer support, care, and hope, right here at home!
Financial Assistance- To address unmet needs of M.S. individuals.

Susan Reynolds, nurse educator for the Tri-State M.S. Association, welcomes appointments at the office or she is glad to talk to you by phone. She can help address questions regarding M.S. medications, side effects, symptom management, or the disease in general. She can also advise you regarding obstacles you encounter because of M.S. She herself has been living with the disease for a number of years.

Offering support, care, and hope…right here at home! Call us today!

Financial Assistance

The Tri-State Multiple Sclerosis Association’s Financial Assistance Program is designed to address the unmet needs of M.S. patients. Any resident of the Tri-State area living with a diagnosis of M.S. is eligible to apply for assistance. Applications are available on our website (download or fill out the form below) or by phoning a request to our office at 1-866-514-4312 or 812-423-5943.

Two requirements must be met in order to be considered:

A statement from your neurologist or primary care physician on their official letterhead confirming your diagnosis.
Completion of the financial/medical assistance application available below (PDF download, or fill out online form).

These documents can be submitted in person, by email, or by fax.
Address: 971-C South Kenmore Drive, Evansville, IN 47714
Email: director@tristatems.org
Fax: 812-423-5650

Contact us at 812-423-5943 with any questions.

Applications are initially reviewed by a staff member to ensure all necessary information has been obtained.

Once complete, the application is forwarded to one or more members of the Financial Assistance Committee who determine what monies can be awarded and any action steps that will be required on the part of the applicant. The application review process will be completed as quickly as possible, but the process may require several contacts with the applicant.

Applicants will be advised of other possible resources for financial assistance that should be explored before the association reviews the need. All applications will remain confidential, with information being shared with staff members, board members, and Financial Assistance Committee members involved in the determination.

It may be necessary for the Tri-State M.S. Association to contact parties listed on the application to verify or clarify information or to negotiate payments. Release of information is included in the application. If the Tri-State M.S. Association grants any monies, they will be paid directly to the vendor owed, not to the applicant.

Applicants receiving assistance will not be eligible for assistance for one year from the time of the award. Applications should be submitted to the address or fax noted on this letterhead.

Tri-State M.S. Association is the sole owner of and the only organization that uses the information collected on this site. We will not sell, share, or rent this information to others under any circumstances.

GET STARTED TODAY

Download the Financial Application

Download PDF

OR FILL OUT THE ONLINE FORM BELOW

Financial Assistance Form

Applicant's Contact Information

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone

Date of Birth

Email(Required)

Enter Email Confirm Email

List of Other People Living at This Address:

Please include name, age, relationship to you, and employer. Select the “plus” symbol on the right to add more people.

Name

Age

Relationship

Employer

What amount of financial assistance are you requesting?

Briefly state how this financial assistance will be used if it is granted.

Have you requested financial assistance from any other agency regarding this need?

Health Information

Please have your physician fax a note confirming your diagnosis of M.S. to us at fax # 812-423-5650.

Date of M.S. diagnosis

Year only is acceptable.

Current Neurologist’s Name:

Neurologist’s Office Phone Number:

Current Family Doctor/Primary Care:

Family Doctor’s Office Phone Number:

Name of health insurance: