Apply For The Pay It Forward Program

Please provide written responses to all the questions in the questionnaire below. Once you have completed the questionnaire, please email it to Payitforward@Deschamps-Braly.com to be considered.

Please note that the Deschamps-Braly Clinic and the Pay It Forward program are separate entities. Kindly refrain from contacting the Deschamps-Braly Clinic directly, as their phone lines are reserved for current patients. Thank you for your understanding and cooperation.