The BSTTW Medical Application Form offers burn
victims and burn survivors from around the world who do not have medical insurance and/or the finances to pay for medical treatment, to
apply for free medical care.
Below is a list of what must be submitted along with the BSTTW Medical Application:
1. The BSTTW Medical Application must be filled out, signed and
notorized. You can download the application at
BSTTW Medical Application Download.
In order to view the BSTTW Medical Application, you must have Acrobate Reader installed
in your computer. If you do not please download it before trying to read the BSTTW Medical Application.
The Acrobate Reader is free of charge. You can download the program by clicking the Adobe Icon
2. You must write a letter to BSTTW expressing your burn injury,
when it was, what medical treatment your received, what is happening in your life today, do you work (if yes, were and how much your
income is), if married how much your husbands income is, do you have medical insurance and what medical treatment you are requesting.
3. A list of the names of all doctors who offered you treatment due to the burn injury.
4. A letter from your primary doctor and specialist(s) stating the diagnosis and what medical treatment
is needed at this time.
5. If you and/or your husband are employed you must submit:
A. The name, address, contact individual and telephone number of the employers.
B. The monthly and yearly income of each individual and combined totals.
C. The Social Security Number of you, your husband and children.
6. If you are on medications, a list of all medications you are currently taking.
7. BSTTW will need the following
pictures: before the burn injury, most recent pictures after the burn injury, pictures during recovery and current pictures of you. This
will help BSTTW and the doctors have a better understanding of your needs.
You must mail all of the above to BSTTW. Our mailing