Fill out this lovely form to be helped! Crush cost is looking for a few folks to help with their medications for free as a part of a pilot service Please, let us help you. We need people to test this service on so we can bring it to the masses.Only available for U.S.A. residents at this time.– Grant First NameEmail AddressPhone NumberWho Needs Help?MyselfA Loved OneWhich State Does the Person Who Needs Help Live In?How do you prefer to be contacted?EmailPhone callDoes the person who needs help have insurance?YesNoidkTell us about the situation. Specifically, are there any medications your local pharmacy cannot get that you need? Which medications are they? Are there any medications that are too expensive? How much are you paying for them currently?0 / 180Send Message