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

  • are residents of Montgomery County, Indiana;
  • have a household income at or below 300% of the Federal Income Guidelines (see household sizes below);
  • do not have health insurance, Medicaid/HIP 2.0, or Medicare

If you meet these criteria, we encourage you to complete an online application. Applications are also available to download in English and Spanish and available at the Clinic. Once you have the form completed with all documents listed below. 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 to speak with our staff about registering for care.

The Montgomery County Free Clinic does not discriminate based on immigration status or other personal characteristics. 


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.  See eligibility guidelines, below.

Apply for Health Coverage

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 the eligibility guidelines, below:

2018 English Eligibility                                         2018_Eligibility_Form_(Spanish)

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. 2018 Federal Income Guidelines.

  • You may download a Medical Health Questionnaire which also must be completed by clicking here.