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Community Event Request Form

Thank you for your interest in partnering with Lawndale Christian Health Center. LCHC is a Certified Application Counselor Organization and our Outreach Specialist can provide on-site Affordable Care Act Marketplace enrollments. Outreach Specialists also provide information about health insurance and payment options as well as detailed information on LCHC and the services we offer.

Acknowledgment

I am requesting a LCHC Outreach and Enrollment Specialist to participate in our organization/church/school health event on the date listed below. I understand that this request is subject to approval. I understand that this form must be received two weeks prior to the date of the health event.

Contact Information

Event Information