Hey Sis

Hey Sis

We are here to help you through your journey. Please use to let us know how we can help.
Name*
Email Address
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Who is this service request for?
Date
Name of Sister

First NameLast Name
Service Requested

Bill Payment AssistanceBoobie ShowerChaplin ServicesComfort KeeperCommunity Based ReferralFloat Forward (Coming Soon)Job Placement AssistanceMeal ServiceNutrition CounselingRenew & Rise (Mental Health)TransportationWaiting Room WatcherWig SelectionOther
MEAL SERVICE MUST BE REQUESTED VIA https://form.jotform.com/243156227758059
RENEW & RISE MUST BE REQUESTED VIA https://form.jotform.com/243516437774161
WIG SELECTIONS MUST BE REQUESTED VIA https://www.myskcle.org/booking-calendar/wig-pickup?referral=service_list_widget
WAITING ROOM WATCHERS MUST BE REQUESTED VIA https://form.jotform.com/243236550233045
Please add details related to your request. Be as specific as possible as this will help us process your request quickly.

Bill Payment Assistance
All payments will be processed within 5 business days of the Service Request date and reciept of all necessary items including proof of diagnosis and service agreement.

Please note:
- A full copy of the current billing page that includes name, full address, account number, amount due.
- Not providing the required information will delay processing. Finance will change SR status to “ follow up needed” if unable to process the payment.
Amount Requested
Upload a full and clear copy of your bill

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