Please complete this form to redeem your free backpack voucher.
Once you hit "submit" your voucher will be on the following screen.
Name
*
Which Adelante Healthcare location do you plan to visit?
*
Please Select
Mesa
West Phoenix
Buckeye
Central Phoenix
Gila Bend
Goodyear
Peoria
Surprise
Wickenburg
Email
*
example@example.com
Phone Number
*
Format: 000-000-0000.
By checking the box below, you consent to receive marketing and promotional emails and texts from Adelante Healthcare.
*
I consent.
By checking the box below, you acknowledge that you have read and agree to the terms and conditions of this promotion: "Terms and conditions apply. While supplies last. 1 backpack per school-aged child that completes a well-child check. Only valid between the dates of July 15th, 2024 - August 16th, 2024. This voucher does not guarantee a backpack."
*
I have read and agree to the terms and conditions.
Submit
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