Care Through Medicaid

We’re honored to offer no‑cost care to some patients with Medicaid. Because we’re a small nonprofit and don’t bill Medicaid directly, we can’t accept everyone, but we do our best.

To be considered, fill out the form below. We’ll reach out as we approach opening. Your info helps us plan thoughtfully and transparently.

*We use this info to plan and to understand needs. It does not guarantee you’ll receive care.

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.