Application For Free OnDoc Healthcare

How To Apply?

Please fill out the form below to the best of your ability, and share this page with anyone that you feel could benefit from receiving free healthcare.  After we gather all the applications, we will get in touch with those who applied.  Please only apply if you truly need this service, we would like to help those who can benefit the most.  

 

We will stop accepting applications on Friday September 7th, 2018.

 

OnDoc Free Healthcare Application

  • Who Are You?

    Please answer the questions below to the best of your knowledge. Remember we are only looking for families that truly need our services free for one year.
  • Household Info

    This information will be kept confidential and private.
  • Please enter a number from 1 to 20.
    OnDoc will provide all household members the same service for free if selected
  • Please enter a number from 1 to 20.
  • Why You?

    I agree that the information entered above is accurate to the best of my knowledge. I also agree to OnDoc's Privacy Policy & Procedures.