Healthy D.M.V. ~ CV-19 Rescue

Intake Form

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Emergency Point of Contact Information:
Health care team of professionals
(844) 549-4266
I consent to the following personal information being collected on my behalf by Healthy D.C. & Me Leadership Coalition for the sole purpose of helping me to find mental wellness, employment, social service, medical, and other resources in order that I can change my current life circumstance for the better. I release and hold harmless Healthy D.C. & Me Leadership Coalition, its affiliates and representatives from any future claims that may arise as a result of their intent to advocate on my behalf.