By signing and submitting this Application, you consent to and authorize the Vital Cares Foundation, Inc., to obtain information directly from the Vital/Femwell Entities with respect to your income and benefits received, or for which you are eligible to receive, from any one or more of the Vital/Femwell Entities.
Once your application is received, the Foundation will assess your stated needs and verified loss. The Foundation's Relief Fund Committee may conduct interviews and request additional documentation, including a copy of your most recent income tax return, to further determine the extent of your financial need and the scope of your damages.