Request a Scholarship

Please complete the form below and we'll do our best to support you (depending on how much we have in our Scholarship Fund). While we need to function as a business, we are passionate about quality accessible healthcare, so we will do our best to help you!

Name

First Name

Last Name

Email

Phone

Country

(###)

###

####

What is your postcode/ZIP code?

What is your financial situation?

Why do you want to join the Matilda Health Program?

How did you hear about us?

Surgery date (if known)

MM

DD

YYYY

Surgeon's name (if known)

Scholarship Acknowledgement Disclaimer

I understand that scholarships are subject to availability and I am not guaranteed a discounted spot

Yes

Two women walking away on a sandy beach with dunes and sparse vegetation, under a cloudy sky.

Aerial view of a mountainous region with ridges and valleys formed by dark and light-colored sediment and rock.

A woman is speaking at a microphone in front of an audience, smiling and gesturing with her hand on her chest. There are two people in the foreground, one with the back of their head visible, wearing a shirt with the word 'Matilda' on it. The background includes a white wall, a potted plant, a banner, and a shiny disco ball hanging from the ceiling.

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