APPLICATION FOR MEDICAL SERVICES
You can download the Bethesda Health Clinic Application for Medical Services from the button below.
This package includes the qualifications to become a patient, a list of the documents you must provide, the application, a Waiver of Liability for Treatment, and a Dismissal Policy Acknowledgement.
Downloading, printing, reading and completing the package prior to visiting Bethesda Admissions is advisable. This will help ensure that you have all the information and necessary documents required to process your application.
Bethesda Admissions is open Monday-Thursday, 10:00AM-1:30PM, on a first come first served basis. The last Admissions appointment will be taken at 1:15. If you arrive after 1:15, you will not be able to be screened until the next business day.
HOW TO APPLY
HOW TO APPLY - STEP 1
- Low income adult
- Employed or perform an important unpaid job, such as being a caregiver, volunteer or participant in a self-improvement program (e.g. education, rehabilitation, etc.)
- Uninsured or underinsured
HOW TO APPLY - STEP 2
- Completed application and waiver forms
- A current government-issued photo ID
- If applicable or available, a recent paystub dated within the last 30 days.
- If applicable or available, pages 1 and 2 of your latest filed tax return (form 1040)
HOW TO APPLY - STEP 3
- You must appear in person at the clinic during admission screening hours.
- Children are not allowed in the screening room. Please make arrangements ahead of time.
- We do not always have a bi-lingual admissions consultant available. If you speak Spanish, please bring an English-speaking interpreter.
- Bring your paperwork from Step 2.
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