“Please don’t be sad. Mommy’s going to find out how we can all help Daddy get better. We need to understand why he doesn’t feel very good.”

The Michael Wilkerson, MD, Family Assistance Fund was created in honor of the contributions made by Dr. Wilkerson while he served as NCPHP Medical Director from 1998 to 2004. Grants from this fund are awarded to the families of impaired physicians, PAs, veterinarians, and RVTs who are entering into residential treatment upon recommendation of NCPHP. These grants are designed to allow family members the opportunity to participate in the family program portion of the treatment process, thus strengthening the impaired practitioner’s support system. Funds will also be available to assist in the event of financial crises in the absence of the impaired family member.

Many of you know firsthand the importance of strong family backing in maintaining good recovery. Can you help a colleague in need of this invaluable support by making a contribution to the Family Assistance Fund?

Payment by check enclosed $______________.
Please charge my credit card the sum of $_______________.
I would like to make a pledge as follows: Charge my credit card at monthly intervals beginning on (date) _____/______/_____ in the amount of $_________ per month for __________ months.
Credit card information: VISA MasterCard
Account # _____________________________________________
Exp. Date ___________

Signature: __________________________________________________________________

Please print name: ___________________________________________________________
Billing Address: ______________________________________________________________
City, State, Zip: _______________________________________________________________

Please mail completed form with your check to:

NCPHP
220 Horizon Dr
Suite 218
Raleigh, NC 27615

You may fax this completed form with credit card information to (919) 870-4484 if you prefer. You will be provided a receipt for your tax-deductible donation.

FINANCIAL INFORMATION ABOUT THIS ORGANIZATION AND A COPY OF ITS LICENSE ARE AVAILABLE FROM THE STATE SOLICITATION LICENSING SECTION AT 1-888-830-4989. THE LICENSE IS NOT AN ENDORSEMENT BY THE STATE.

To apply for a family assistance grant, please email Kim Lamando