App Sign Up
In keeping with our mission and vision, we are developing an app that will easily connect Black women to healthcare providers who look like them. While the Beta version of this app is intentional about its focus on Black women (a group that often gets overlooked and dismissed), we believe this platform will be beneficial for people of color as a whole.

If you are interested in being a Beta user of this app, please complete the form below. Thank you.

Email address *
First Name *
Your answer
Last Name *
Your answer
How do you plan to use the app? *
Required
Where are you based? (City, State) *
Your answer
What is your age range? (Optional)
Do you feel this app is needed? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Health In Her HUE. Report Abuse - Terms of Service