APPLICATION FORM

Apply so we can help!

Are you a doctor in a village in rural areas of Africa and in need of healthcare supplies and medicine?

Fill in the information below and we will contact you as soon as possible to create a plan to support your village with medical supplies and medicine!

Go back

Thank you for applying! We will contact you as soon as possible.

Name

Adress village

Condition of the village

Number of villagers

Number of medical workers

Condition of dispensary/hospital

Which medical equipment is needed? And why?

Which medicine is needed? And why?

Message to us

You can send attached documents and pictures of the villages dispensary/hospital once we respond to you on email.

*We are currently not taking any applications but will be available again from november 2025 🙂 Don’t hesitate to contact us then!