BECOME A PATIENT

STEP ONE

Fill out our quick prequalifying form to see if you’re eligible to get care at Hope House.

Show Form

STEP TWO

If you qualify, download and fill out our required forms. Turn them in to the clinic at your first appointment. If you don't have access to a printer, please fill out the form and email it to the clinic.

View Forms

STEP THREE

Call or visit our location to set up an appointment. Make sure you bring:

  • patient forms
  • evidence of no insurance
  • pay stub
  • identification

PREQUALIFYING FORM

Check the box that most applies to you.

I am uninsured.

I am an individual making less than $31,255 a year.

My partner and I are making less than $42,275 a year.

My family of four makes less than $64,375 a year.

None of these apply to me.

Yes, you are eligible to get care.

Please contact us if you have any questions about setting up an appointment.

Sorry, you are not eligible to get care.

Please contact us if you have any questions about getting medical care in the community.

WHO YOU'LL SEE

Dr. Marla Vance

Sarah Smoes PA-C

Dr. Thomas Wright

PATIENT STORIES

“I HAVE BUILT A NEW RELATIONSHIP WITH JESUS CHRIST…”