Alabama Free Clinic is a 501(c)(3) Tax-Exempt Organization 

 

Our Mission is to improve the overall health of Baldwin County by providing
no-charge medical care and health education programs 
for adults who are without medical insurance.

 

 

Patient Application

Thank you for your interest in being a patient at Alabama Free Clinic!

 
Patients are seen by appointment only; no walk-ins are accepted. 
 
To Become a Patient:
  • Call the clinic office at (251) 937-8096
  • Complete a phone screening
  • Provide requested documents (see below)
 
To expedite your pre-approval and care, please fill out the online form below and upload the required documents:
  • Photo ID
  • Social Security Card
  • Proof of Income
  • Proof of Residency (lease, utility bill: gas, water, electric bill)
 
You may download the application here and mail your required documents to:
Alabama Free Clinic
P.O. Box 1284
212 Courthouse Square
Bay Minette, AL 36507
 

Patient Online Application

Household Size and Verification

Enter all members of your household, their relationship to you, their date of birth, and source of income

Upload Your Documents Here

Patient Information and Income Verification

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Emergency Contact Information (different name and number from above)

I, the undersigned, understand and agree that the Alabama Free Clinic, Inc. provides medical services under the Volunteer Medical Professional Act at no cost to me. I further understand that the doctors and other healthcare professionals who provide free services are not liable for civil damages as a result of his or her acts or admissions in providing medical treatment, diagnosis, advice, nursing services unless the act of admission was the result of the licensed healthcare provider's willful or wanton misconduct.

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