Community Health Initiative

Free Community Health Camp

Free medical consultations, health screenings, and wellness services at Ved Mandir, Milltown NJ — Saturday 25 July 2026.

✓ Free for Everyone ✓ No Insurance Required ✓ Tax-Deductible Donations ✓ HIPAA-Compliant Registration

👤 Personal Information

Please enter your first name.
Please enter your last name.
Please enter your date of birth.
Please enter your street address.
Please enter your city.
Please select your state.
Please enter a valid ZIP code.
Please enter a valid phone number.
Please enter a valid email address.

🩺 Medical Information (optional unless noted)

🆘 Emergency Contact *

Please enter an emergency contact name.
Please enter the relationship.
Please enter a valid emergency contact phone number.

⚖️ Consent & Privacy — New Jersey *

📋 HIPAA Privacy Notice
The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of your individually identifiable health information. The information you provide in this form will be used solely for the purpose of providing free medical consultation and services at the Community Health Camp. Your data will be kept confidential, stored securely, and will not be shared with any third party without your explicit written consent, except as required by law. You have the right to request access to your information and to request corrections. For more details, please ask for our full Notice of Privacy Practices at the event.
📜 New Jersey Privacy Rights Notice (N.J.S.A. 56:8-163 et seq.)
Under New Jersey law, you have the right to know what personal information we collect, how we use it, and with whom we share it. We collect your name, contact information, date of birth, and health-related information solely for the purpose of providing free medical services at this health camp. We do not sell your data, share it with third parties for marketing, or retain it longer than necessary. You have the right to request access to, correction of, or deletion of your personal information, subject to legal and medical record retention requirements. To exercise these rights, please contact our Privacy Officer at the event or via email at privacy@donorscollective.org.
🔒 HIPAA & NJ Data Protection: All information collected is protected under HIPAA and the New Jersey Consumer Privacy Act. Data is stored in a HIPAA-compliant environment with a Business Associate Agreement in place. Your information will not be used for any purpose other than providing care and coordinating follow-up services.
* Required fields. All information is collected in compliance with HIPAA, New Jersey privacy laws (N.J.S.A. 56:8-163 et seq.), and applicable medical record retention regulations.
All fields marked * are required.
💛 Support This Health Camp

Help us keep care free for everyone.

Donations made to Ved Mandir and/or Donors Collective are tax‑deductible under the law. Every contribution helps cover medical staffing, screenings, and supplies for this health camp — feel free to contribute towards a healthier society.

Donate via PayPal or use bank transfer below for zero fees

🏦 Direct Bank Transfer PREFERRED — ZERO FEES

100% of your donation reaches the Health Camp — no PayPal fees deducted.

Account Name Donors Collective
Account Number 875109261789
Routing Number 125109019

After transferring, email donorscollective@gmail.com with your name and amount to receive your tax receipt.

💳 PayPal Donation

Fee Notice: PayPal charges approximately 2.9% + $0.30 per transaction. These fees are deducted from your donation before it reaches us. For maximum impact, please use the bank transfer option.

You can still donate via PayPal using any major credit or debit card — just be aware of the processing fee.

Donate via PayPal

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