Financial Assistance "*" indicates required fields EmailThis field is for validation purposes and should be left unchanged.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.Family AdditionalsFamily Additional Total 5500Yearly Rate 15650Calculated % FPLAnnual Income
