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Apply for medical and/or dental services here.

Application for Medical / Dental Services

If you are a new applicant or a renewing patient, please enter all of the required and applicable fields in the application below. 
Required fields are indicated by a red asterisk (*).


Bethesda Medical patients have the option to have a Patient Portal account. With the Patient Portal you can request medical appointments, upload income information, send & receive messages, view lab results, and more.


Dental Applicants Only

Due to high demand, we are unable to schedule new dental appointments until October. New patients are encouraged to still apply, but please note the first available appointment will be in October, 2021.

I Understand:

  • A 50% or $20 deposit is required at the time of scheduling each dental appointment and a refund cannot be given.
  • My initial visit fee will be $70. $20 is due when scheduling the appointment and $50 is due upon my arrival of the appointment.

All Applicants

I Understand:

  • I am required to pay my office visit co-pay, dental initial visit fee, and/or any other office visit fees each time I have an appointment at Bethesda. If I cannot pay, I may not receive care and may be referred to a patient advocate to be matched up with other resources. All co-pays and fees must be paid in cash or by credit card.
  • Fees for all dental services, labs, x-rays, women’s health, and specialty services are separate. They may be in addition to my medical office visit co-pay, dental initial visit fee, and will vary depending on the test or procedure.
  • If I miss a scheduled appointment and fail to provide at least 24 hours advance notice it could impact my eligibility as a Bethesda patient. Failure to appear at my initial visit or the cancellation of any three appointments can result in my dismissal as a patient.
  • If I cancel an appointment on the same day as that appointment or if I miss an appointment and do not call ahead, I will forfeit any prepaid fees for that appointment.
  • If I am over 10 minutes late, to any appointment, I will not be seen.
  • Specialty services and referrals at Bethesda are limited. They are prioritized for patients where Bethesda is their primary healthcare provider. Not all patients will have access to specialty services and/or referrals.

By clicking the Submit button below, I hereby declare that the above information is true and correct. I know that any false information could jeopardize my eligibility to receive medical and/or dental attention at Bethesda Health Clinic.


If you have any questions regarding this process or what to bring, please call our Admissions Department at
(903) 596-8353 ext. 109 or email

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