to become a patient, please:
Complete a new patient application. You can download one by clicking the appropriate application button below.
Only completed applications with copies of the required documents will be processed.
In addition to a completed patient application, the following documents are also required:
Copy of Social Security Card (if available) for each applicant
Copy of picture identification for each applicant
To be screened for eligibility for the Sliding Fee Discount applicants must also provide family size and proof of earned income through one of the following document(s):
Current Federal income tax return
Social Security or disability letter (must be a letter from Social Security Administration)
30 days paystubs (most recent)
Unemployment Benefits (must be a letter from Unemployment department)
Letter from a shelter on organizational letterhead where applicant resides
Letter from employer on company letterhead documenting the hours worked and rate of pay or signed and notarized GSCC Employer Declaration Notice
Department of Human Services Child Support Statement or proof of alimony
Self-declaration on GSCC Self-Declaration Form is allowed for homeless individuals/families
ALL paperwork must be completed prior to being seen at the clinic.
TO QUALIFY FOR A SLIDING FEE DISCOUNT:
Patients must provide family size and proof of income that verifies income levels are at or below 200% of the Federal Poverty Level.
English Applications and Forms:
Aplicaciones y formas en Español:
Manuel del Paciente:
Good Shepherd community clinic, Inc.
Twenty 12th Avenue NW
Ardmore, Oklahoma 73401
Medical Appointments: 580.223.3411
Dental Appointments: 580.223.2006
Monday 9a to 6p
Tuesday 9a to 6p
Wednesday 9a to 6p
Thursday 9a to 6p
Friday 8a to 12p (Walk-In Urgent Care Only)