Financial Assistance "*" indicates required fields Thanks for using our Eligibility Checker for Financial Assistance! Answer the following questions to see if you may be eligible for a discount on your Demo Health bills.Name First Last Date of BirthDo you have health insurance?* Yes No Including yourself, how many people are in your immediate family?*Immediate family defined as the responsible party, their spouse if applicable, and all dependent children under 18 years old.Please enter a number from 1 to 10.What is your estimated gross MONTHLY household income?*This is current household monthly income before taxes.Please enter a number from 0 to 1000000.This field is hidden when viewing the formFamily AdditionalsThis field is hidden when viewing the formFamily Additional Total 5500This field is hidden when viewing the formYearly Rate 15650This field is hidden when viewing the formCalculated % FPLThis field is hidden when viewing the formAnnual IncomeCommentsThis field is for validation purposes and should be left unchanged.
