Patients with Medicaid requesting care at The Iris Center

We’re honored to offer care at no cost to some patients with Medicaid.

Because we’re a small nonprofit clinic and we don’t bill Medicaid directly, we aren’t able to accept every Medicaid patient—but we do our best to serve as many as we can with the time and care every person deserves.

If you have Medicaid and would like to be considered for care at The Iris Center, please complete the form. We’ll be in touch as we get closer to opening.

This information helps us plan our patient panel with thoughtfulness and transparency.

We are not currently open for appointments, but filling out this form puts you on our contact list for future availability.

Your name (as you’d like to be addressed)

Whatever name you’d like us to use when we reach out. No need for legal names here.

First Name

Last Name

Email Address

Phone Number

(###)

###

####

Date of birth

Medicaid requires this for eligibility and identity confirmation.

YYYY

ZIP code

Helps confirm you’re within reach of care.

Do you currently have active Medicaid coverage?

Briefly share why you’re seeking care at The Iris Center

This helps us understand your needs and plan accordingly.

Consent

I understand that submitting this form does not guarantee care or create a patient relationship. I am submitting this request to be considered for future care through The Iris Center’s Medicaid-supported program.

Patients with Medicaid requesting care at The Iris Center

We’re honored to offer care at no cost to some patients with Medicaid.

If you have Medicaid and would like to be considered for care at The Iris Center, please complete the form. We’ll be in touch as we get closer to opening.

Radically Human Healthcare.