Please answer a few questions to help us identify how we can help you Health Justice Initiative helps with legal advocacy for the following issues: Health Care Discrimination, Medical Bills, and Insurance Access. Your name(Required) Your Name Preferred method of contactEmailPhoneYour email(Required) Your phone(Required)Who is in need of service?(Required)Please select all that apply. Household with income below the poverty level BIPOC individual Immigrant Child Woman LGBTQ+ Household size(Required) 1 2 3 4 or more Is your income less than $2300 per month? Yes No Is your income less than $3000 per month? Yes No Is your income less than $4000 per month? Yes No Is your income less than $5000 per month? Yes No Please describe your situation(Required)NameThis field is for validation purposes and should be left unchanged.
