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BQ+ Healthcare Navigation Program Eligibility Form

This form will allow for us to schedule you an appointment to meet with a healthcare navigator.
MM slash DD slash YYYY
Name(Required)
Pronouns
MM slash DD slash YYYY
Upon review of this form how would you prefer to be contacted by a marketplace healthcare navigator ? Please check all that apply.(Required)
Do you have healthcare coverage?(Required)
Is healthcare coverage offered by your employer?(Required)
Do you currently have a marketplace account?(Required)
The marketplace account would be found on healthcare.gov
Are you currently employed?(Required)
Which of the following barriers are you facing for access to care?
This field is for validation purposes and should be left unchanged.

About Us

The Normal Anomaly Initiative, Inc.
10039 Bissonnet Street, Suite 310,
Houston, Texas 77036

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Latest News

  • Black Queer Music Festival Expands to Bring More Purpose to Partying March 6, 2023
  • Black TransWomen Deserve to Grow Old! June 16, 2022
  • LOCAL HOUSTON HIV ADVOCACY ORGANIZATION, THE NORMAL ANOMALY INITIATIVE, TO RECEIVE DONATIONS FROM LIL NAS X “BABY REGISTRY” March 29, 2022

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