Apply for Reduced Co-Payments

Secured with 256-bit SSL encryption

Our Reduced Copayment Program ensures that anyone can afford to work with Easy Does It. If you fall below the federal poverty line, you can get half off your bill for all of our paid services. Please provide your contact information and two forms of income verification to get started.

Call to Apply

If you are unable to fill out this webform, you can call our Urgent Dispatch Line and a Team Member will help you apply over the phone.

Call to Apply, (510) 704-2111

Page 1

Contact Info

First Name

Last Name

E-mail Address

Phone Number

Demographics

Number of Adults in your Household

Number of Children in your Household

Page 2

In order for us to process your reduced Co-Payment Application, we need to verify that you're eligible for them. Please provide us with two forms of income verification, this information remains confidential and is required to proceed.

First form of Income Verification

Please submit any of the following documents which shows you're enrolled in any of the following programs:

Medi-Cal
CalFresh/SNAP/EBT
CalWorks
Other

Upload your First Document Here

Second form of Income Verification

Attach one of the following documents to verify your income:

Bank Statement
Payroll Stub
Tax Return (most recent)
Self-certification letter
SSI statement
Other

Please remove any account numbers, social security numbers or other confidential information.

Upload your Second Document Here