Qualify & Apply for Financial Assistance

Must be a current resident of the United States.
Medical bill(s) must only be associated with a miscarriage, stillbirth, or related funeral home expenses.
Must be able to provide documentation of bills with a current balance due.
Must must be able to provide one of the acceptable bill verification options.

Complete the fields below and submit to Love, Jessica.
Once submitted, you will receive an email response within approx. 1 week with the next steps.
Submit acceptable bill verification document/s
Payments issued are paid directly to the institution issuing the invoice.

Itemized bill that clearly states miscarriage or stillbirth.
Certificate of stillbirth
Letter from Doctor/Hospital on their letterhead stating miscarriage/stillbirth and the date/s of service. *must be emailed from Doctor/Hospital*
Give authorization, written or verbal, per their requirements, for Love, Jessica Inc. to call and confirm the charges.

Application

Name*

Email*

Phone Number*

Your Date of Birth*

Your Address*

How did you hear about us (please be as specific as possible)*

How far along was your pregnancy?*

Baby's Name?*

Baby's Birthday/Date of loss?*

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