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“It sure is great to have access to medical care when I need it – even with my limited budget.”


Application For Patients
There are several ways to apply.

  1. Print an application form from the list below, follow the instructions, enclose all necessary documents and mail it to the address on the application form.
  2. Register at a local registration site. You must call the registration site for an appointment and bring proof of address and proof of income. By applying at a site, you will receive a copy of your application.
  3. If you cannot go to an intake site, call 708-531-0680 and request an application be mailed to you. When received, follow the instructions and enclose the necessary documents.


Without all the necessary documentation, your application will be delayed.


English Application form

Spanish Application form