Become a Patient

Welcome to The Free Clinic! We are dedicated to providing high-quality, compassionate healthcare services to individuals and families in our community who may not have access to traditional medical care. Our mission is to ensure everyone receives the care they need, regardless of their financial situation. As a free clinic, we offer a wide range of services including primary care, preventive screenings, chronic disease management, mental health support, and more—all at no cost or on a sliding scale based on income.

If you’re interested in becoming a patient, we’re here to make the process as simple and straightforward as possible. Below, you’ll find detailed information on eligibility, a step-by-step guide, required documents, what to bring to your first visit, and our patient registration form. If you have any questions, please contact us at (216) 766-0492 or email [email protected].

Step-by-Step Guide to Becoming a Patient

1. Contact Us or Walk In: Call (216) 766-0492 to schedule your intake/registration visit, or stop by during our open hours (Monday–Friday, 9 AM–5 PM; extended evening hours available—check our Contact Us page for details). Walk-ins are welcome when capacity allows.
2. Complete the Patient Registration Form: Fill it out online below (secure submission), download and print it, or complete it in person at the clinic. This form collects essential information to help us provide personalized care.
3. Bring Basic Identification (if available): We keep requirements minimal—see the list below. If you don’t have certain documents, that’s okay; we can still register you and begin care.
4. Attend Your Intake/Registration Visit: A friendly staff member will review your information, answer questions, discuss your health needs, and register you as a patient. This visit usually takes 20–40 minutes.
5. Get Connected to Care: You’ll receive your patient information and can schedule your first medical appointment right away (or soon after, depending on availability). We offer primary care, preventive services, chronic disease management, mental health support, referrals, and more—all at no cost.
6. Return as Needed: Once registered, access our services whenever you need them. We encourage regular check-ups and ongoing support.

Wait times vary based on demand—calling ahead helps us serve you faster.

Required Documents

We keep paperwork to a minimum to remove barriers:

• Photo ID (if you have it): Driver’s license, state ID, passport, or other government-issued photo ID (helpful but not required for basic services).
• Any existing medical information (optional but very helpful): List of current medications, recent lab results, immunization records, or notes from other providers.
• For children/minors: Parent/guardian must attend and provide verbal or written consent. Birth certificate or school ID is helpful if available.

No proof of income, no insurance card, no residency documents, and no citizenship papers are required. If you have any of these and want assistance (e.g., applying for public programs), let us know—we can help connect you.

What to Bring to Your First Appointment

To make your visit smooth and efficient, please prepare the following:

• Medications: Bring all current prescriptions, over-the-counter medications, vitamins, or supplements in their original bottles.
• Health History Notes: Jot down any allergies, past surgeries, family medical history, or symptoms you’re experiencing.
• Comfort Items: Water, snacks (if you have dietary needs), reading material, or a notebook for notes.
• Transportation Plan: Arrange for reliable transport to and from the clinic.
• Interpreter (if needed): If English is not your primary language, bring a trusted interpreter or let us know in advance so we can arrange one.
• Face Mask and Hand Sanitizer: For your safety and ours, especially during flu season.

Arrive 15 minutes early to complete any last-minute paperwork.

Patient Registration Form

Submit this secure form online, print and bring it, or fill it out at the clinic. All information is confidential and protected under HIPAA.

Patient Information

• Full Name: _______________________________
• Date of Birth: //____
• Gender: _______________________________
• Preferred Pronouns: _______________________________
• Preferred Language: _______________________________
• Address (if stable/have one): _______________________________
• City: _______________________________ ZIP: _______________________________
• Phone Number: _______________________________
• Email (optional): _______________________________
• Emergency Contact Name: _______________________________
• Emergency Contact Phone: _______________________________
• Relationship: _______________________________

Health Information

• Primary Reason for Seeking Care: _______________________________
• Current Medications (list all): _______________________________
• Allergies (medications, food, etc.): _______________________________
• Major Past Medical Conditions or Surgeries: _______________________________
• Do you currently smoke? Yes/No
• Do you use alcohol or other substances? Yes/No (details optional)
• Any mental health or substance use concerns you’d like support with? _______________________________

Additional Notes

• How did you hear about us? _______________________________
• Do you have any immediate needs (e.g., food, housing, transportation support)? _______________________________

Consent

I consent to receive medical evaluation and treatment at The Free Clinic. I understand services are provided free of charge with no requirement for income proof, insurance, or documentation status.

Signature: _______________________________ Date: //____

After submission, our team will contact you within 1–2 business days to confirm your visit or next steps.

Additional Information

• Privacy and Rights: Your health information is protected.
• Services Offered: From routine check-ups to specialist referrals—learn more on our Services pages.
• Urgent Needs: For medical emergencies, call 911. For non-emergency urgent care, contact us directly.

We’re excited to welcome you to The Free Clinic family! Your health is our priority. If you need immediate assistance, visit our Urgent Care page or call 911 for emergencies.