Apply for Gaja Health
Please fill out the below questions to apply and a Health Advocate will call or text if you are eligible.

**Completing this form marks your agreement to the Gaja Health Privacy policy and Terms of use:

- Privacy Policy: https://gogajahealth.com/app/help/privacy-policy.html 
- Terms of Use: https://gogajahealth.com/app/help/terms-of-use.html 
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First name *
Last name *
Email address *
(We promise to keep your email private)
Mobile phone number *
For example: 555-333-444  - (we promise to keep your phone number private)
Zip code *
(Currently, Gaja Health requires participants be residents of an Alameda county zip code)
Do you have Medi-Cal insurance? *
To use Gaja Health, you must be enrolled in or eligible for Medi-Cal. Not sure if you are eligible? Click here to check the guidelines: https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx 
What would you like help with? *
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