FreeD.O.M. Health Intake Form

Apply Online URL

https://daley626.surveysparrow.com/s/FreeDOM-Intake-Form/tt-2V462BsJomZAim7LkcH…

Please fill out the intake form, and FreeD.O.M. Clinic will contact you. This form will take around 10 minutes, but due to the overwhelming demand for the free services, RESPONSE TIME TAKES 2 TO 3 BUSINESS DAYS.

Counties

Marion

Use of this website does not guarantee eligibility or access to services. Copyright Orange County Library System Privacy Policy.

This project was funded under the provisions of the Library Services and Technology Act from the Institute of Museum and Library Services. Florida's LSTA program is administered by the Department of State's Division of Library and Information Services.

For FY 2023-2024, 37% of the total costs for the Right Service at the Right Time ($61,891) is supported by federal money; 63% of this project ($103,644) is supported by local funding. The total budget of the project is $165,535.00.