Thanks to the generosity of the participants like you, Assistance in Health Care is able to keep families together during a time of illness. Your support is greatly appreciated.

Please fill in the form below to download the form.

First Name *

Last Name *

E-mail Address *

Phone Number *

Please complete the form and mail to:
Assistance In Health Care, Inc.
P.O. Box 700392
Tulsa, OK 74170-0392

If you are sending a check, be sure to specify that you would like to designate your donation to Buy a Brick on the memo line of your check.

Buy Brick by mail