How to Receive Services at HFHC

If you are a new patient OR are an existing patient that has not received services at Holland Free Health Clinic in the past year:

1. Review the eligibility guidelines below to determine if you qualify for services
2. If you are eligible OR have any questions about our eligibility guidelines, fill out the New Patient Form (click the button below) or call us at (616) 392-3610 so we can schedule you for an intake appointment and get you connected with our services

New Patient Form

If you have received services at Holland Free Health Clinic in the past year and would like to schedule another appointment or become involved in additional programs or services, call (616) 392-3610 or fill out the existing patient form:

Existing Patient Form

Eligibility

Eligible patients are 18 years of age or older AND meet the following criteria:

1. Uninsured or under-insured (Medicaid or other limited coverage)
2. Household income is less than 200% of the Federal Poverty Level
3. Have less than $5,000 (if single) or $10,000 (if married) in savings, 401k, or other retirement accounts

Use the diagram below to determine if you are eligible for services at Holland Free Health Clinic.

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Income Chart (Question 2): to be eligible, your monthly/annual income must be less than the amount listed for your household size. Number in household includes yourself, a spouse, and your dependents (people you are financially responsible for). Income includes salary/wages, child support, social security (disability and retirement), SSI, retirement/pension, unemployment, rental income, workmen's compensation, veteran benefits, and investments.