Good Samaritan Clinic

Motivated by the love of Christ, and in obedience to His Command to serve the Poor; The Good Samaritan Clinic exists to provide Primary Medical and Dental care to the uninsured of the community through Volunteer Providers.

Steps to Qualification:

• This application must be fully completed and all pertinent paperwork must be included.
• Bring the completed application and paperwork to the clinic on a Monday, Wednesday or Friday from 3PM to 7PM. No appointment needed, seen on a first come first served basis.
• Applications and documents must be submitted IN PERSON. We DO NOT accept applications by mail, email, or fax. You MUST meet with the Qualifier.
• You will receive a letter to inform you of your eligibility status. If you are qualified, please call the office to schedule your initial appointment.

Documents Required for Qualification:

• Completed application
• Proof of Identification
• Valid Government Issued Photo ID (ex: Driver’s License)
• Checking/Savings Account Information
• Proof of Residency showing: current address, applicant name/spouse name (Bring one of the following)
• Current rent or lease contract for rented home -or-
• Most recent property tax bill for owned home -or-
• A current month utility bill or service bill -or-
• HOMELESS ONLY: a current registration letter from The Neighborhood Center 434 S. Woodland Blvd. DeLand, FL 32720
• Proof of Income and Assets (bring all that apply)
• For EACH employed household member (applicant, spouse or partner) previous month pay stubs or employer verification
• IF household has a bank account, all pages of most recent month banking statement
• Current SNAP (food assistance) Benefit Letter or EBT card
• Most recent letter from Social Security showing retirement or disability benefits
• Proof of ALL OTHER income including self-employment showing dollar amounts earned
• If you have no income and someone supports you, the Verification of Support form needs to be completed.