We'd love to hear about your needs!


Please complete this survey as soon as possible. Your answers will help us plan clinic services. We encourage you to share as much information as you can.


We will serve as many veterans as possible, but cannot guarantee availability of every service on each day. Capacity is limited and availability of some services will depend on demand.

* Are you available and interested in attending the Care Harbor free clinic on November 4 or 5, 2023?
If Yes, what is your preferred date:
If Yes, please provide your full name and what school you attend:
0/250
If No, please explain why or select one of the following reasons:
0/250
* Do you need dental services?
If Yes, what dental problem do you have?
0/500
When was the last time you saw a dentist or received a dental examination?
0/250
* Do you need glasses or a vision exam?
When was the last time you saw an eye doctor or received an eye examination?
0/250
When was the last time you had a medical exam?
0/250
* Do you have other healthcare needs?
If Yes, please describe:
0/500

Thank you for participating in this survey!
Question Text
0/250
Submit Survey
If you just opted in, you're consenting to receive marketing emails from: Care Harbor, P.O. Box 88507, Los Angeles, CA 90009. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe® link, found at the bottom of every email. Emails are serviced by Constant Contact