Please use this form for Referral Purposes, this is for the 5C affiliate charitable clinic use.
The form is very simple. Follow the steps below.
1- Choose the specialty that you are seeking.
2- Complete filling out the form. The form will show you which one of our affiliated clinic has the specialty you choose in step 1.
3- Once completed the email will be sent to the 5C group email. A member of the 5C will then forward your request to that clinic.
That is it !!