Join the Primary Care Access Program interest list.

Tell us how to reach you. We will contact people on the list about eligibility and next steps for the cohort beginning January 2027. Joining the list does not enroll you or guarantee a place.

Your contact information

Provide your contact details to receive information about eligibility and next steps.

Children under 13 should not submit this form. A parent or guardian can contact us about next steps without sending the child's personal or health details.

contact@sozorockfoundation.org

Read the interest list privacy notice

Fields marked required must be completed. Provide at least one way to reach you.

First name (required)Last name (required)

Email (email or phone required)Phone (phone or email required)

Preferred contact method (required)New York county (required)I live in New York State (required)I am 64 or younger (required)How did you hear about us? (optional, 200 characters maximum)SozoRock may contact me about the Primary Care Access Program. I understand this does not enroll me. (required)

Please do not include medical, insurance, income or other personal health details. Eligibility is reviewed privately later.