The Montgomery County Free Clinic seeks to provide medical care to people and families who:

  • are residents of Montgomery County;
  • have a household income at or below 200% of the poverty level (See household sizes below);
  • do not have health insurance, Medicaid/HIP 2.0, or Medicare

If this describes you then please click here, to fill out an online application. Applications are also available to download and print by clincking HERE and  in print at the Clinic. Once you have the form completed with all necessary documents, please return to the clinic during normal business hours. All applications will be processed on a case by case basis. If you are unsure of your eligibility please fill out an application and stop by the clinic during normal business hours to speak with our staff about registering for care.

If Applying Online:

Once you complete the online application further instructions will be sent to the email address you provided outlining your eligibility and further required documents to be brought to the clinic.  A list of the accepted documents is also listed in this document.

If Applying in Person:

Paper applications will be available at the Clinic.  We also ask that when you come in to fill out your application that you bring one form of picture identification, one proof of residency and one proof of household income, as outlined in this document.

What is 300% of the Federal Poverty Level?

The United States Department of Health and Human Services determines the definition of the poverty level on a yearly basis. Click here for a link describing current guidelines.