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.