Intake form

Name *

Email address *

What type of assistance are you seeking?

Please select at least one option.

Dialysis assistance

Medical mission support

Dental mission support

Calamity relief aid

Humanitarian mission involvement

Please specify your location.

What is your preferred method of contact?

How did you hear about the key of life foundation?

Please provide any additional information or specific needs.

Which service or services are you interested in?

Please select at least one option.

Dialysis patient support

Medical and dental missions

Humanitarian aid for calamity victims

Scholarships for Indigent and Gifted Students

Scholarship Donor Club

Initial consultation for $150

Follow-up consultation for $100

Additional questions or comments

Key of Life Foundation