Be at or below 200% of the Federal Poverty Level or below
Fully complete a new patient application (click the appropriate button below to download an application)

In addition to a completed patient application, one copy of each of the following documents are also required.

Only completed applications with copies of the required documents will be processed.

Proof of income from anyone living in the household
Copy of Social Security card (if available) for each applicant
Copy of picture identification for each applicant
Proof of residency (ie. copy of utility bill)
Proof of earned income, if applicable (must provide two of the following): 
- Food stamps acceptance letter (must be a letter from DHS) 
- Social Security Income (must be a letter from Social Security Administration) 
- Unemployment Benefits (must be a letter from Unemployment department) 
- Worker’s Compensation Benefits (must be a letter from Worker’s Compensation) 
- Housing assistance letter (must be a letter from DHS, Section 8, etc.)
If employed, please provide the following:
- Current tax return - Once income eligibility is approved based on tax return, applicant will be income eligible for clinic services until April 15th the following year. It is the applicant's responsibility as a patient to provide a copy of your tax return each year in order to continue to be eligible for services.
- One month of recent consecutive paystubs for applicant, or if paid by cash, a letter from employer on company letterhead stating rate of pay per hour and number of hours per week worked for the past month for applicant. If applicant is found to be eligible with paystubs or a letter from employer, applicant must re-certify with new documentation every 90 days to ensure continued eligibility.

Twenty 12th Avenue NW
Ardmore, Oklahoma 73401

580.223.3411

Monday 9a to 6p

Tuesday 9a to 6p

Wednesday 9a to 6p

Thursday 9a to 6p

Friday 8a to 12p