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