Facing Forward is a HAVEN program launched jointly by Mass General and Mass Eye and Ear, provides cosmetic and dental reconstructive surgery and other medical procedures to help survivors of physical and emotional abuse move forward in their lives.

After you submit your request, a HAVEN representative will contact you within two weeks to ensure that your application is complete and to ask any preliminary questions.

Important note: Some questions on this form may appear or disappear based on your responses.

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Please call 911 if you are experiencing a medical emergency.