Request Assistance | Tune In Tune Up

Request Assistance

Are you seeking medical, dental, or mental health assistance?

Please take a moment to fill out the form or download the PDF located below.

First name

Last name

Phone

Street address

City

State

Zip code

What type of assistance are you requesting?

Medical

Dental

Behavioral health

Please list any medical conditions and/or diagnoses:

Has treatment been completed?

Current healthcare insurer (if applicable)

Is your health insurer paying for all your medical needs?

What is the name of your current band or music profession?

Do you have a source of income besides music?

How long have you been in this band or music profession?

What percentage of your time do you perform as a musician or work in the music industry?

Please explain to us why you feel you qualify for financial help from Tune In & Tune Up and what impact the financial assistance would have on you: