LPF Limb-Risk Care Package Program

Care Package Request Form

People at risk for limb loss are an overlooked population.  Treatment and recovery can be life-changing, frightening, and traumatic physically, emotionally, and financially.  The LPF Limb-Risk Care Package Program makes a difference for people during treatment who are experiencing extended periods of bed rest during their recovery.  To help them know they are not alone, we provide a care package of basic comfort items along with a beautiful handmade quilt

 

To receive a care package, please complete the form belowTo qualify, the patient must be in active treatment for limb-threatening issues* pertaining to the treatment of tumor, trauma or infection and reside in the Rocky Mountain Region (AZ, CO, ID, KS, MT, NE, NM, UT, WY). 

 

*limb-threatening issues relating to serious risk of losing an arm or a leg not due to diabetes. 

 

Your Contact Information

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Recipient Contact Information

First Name*
Last Name*
Address*
City*
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Phone*
Email*
My/Their condition was caused by:*
Facility Name*
Treating Physician:*

Gift Message

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