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.

Click here to view the Sliding Fee Discount Schedule (SFDS)

 

English Applications and Forms:

Patient Handbook:


Good Shepherd community clinic, Inc.

Twenty 12th Avenue NW
Ardmore, Oklahoma 73401

Medical Appointments: 580.223.3411

Dental Appointments: 580.223.2006


Clinic Hours:

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)