Family Mental Health Care Fund EOB Submission

The Community Foundation of the Texas Hill Country

Family Mental Health Care Fund Explanation of Benefits (EOB) Submission
If you are a person seeking support through the Family Mental Health Care Fund established by the Community Foundation of the Texas Hill Country, please first use this link to complete Family Attestation Form. If you have questions about the Fund or submitting your Explanation of Benefits (EOB), please use this link for answers to Frequently Asked Questions (FAQ).
Full Legal Name*

First NameLast Name
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reimbursement Amount Being Requested*
Explanation of Benefits (EOB) from your insurance provider*

Cancelof
Should be Empty:

The Community Foundation of the Texas Hill Country