Book your appointment

Your appointment will be confirmed once our office contacts you after you complete this form.

Yes No

1. Free Medical/Dental (*Eligibility Required) click here   2. Servicio médico/dental gratuito (*Se requiere elegibilidad) haga clic aquí   3. Juntos nos curamos. Consultas de telesalud, recetas gratuitas (sujeto a disponibilidad), sesiones de asesoramiento, pasajeros de Uber por favor llame al 281-977-7462   4. Together we heal. Telehealth consultations, free prescription (subject to availability), counseling sessions, ubers riders please call on 281-977-7462  

Title V - *Free Prenatal and Postpartum Services (Título V para la atención prenatal y posparto)

*(Eligibility Required - Se requiere elegibilidad)

Prenatal and Postpartum Services During and Up to 90 Days After Pregnancy
  • Complete medical history
  • Physical examination and clinical assessment
  • Family planning services
  • Counseling and education
  • Referral as indicated
  • Routine prenatal laboratory and diagnostic testing
  • Case management

Dental
  • Comprehensive and periodic oral evaluations
  • Radiographs
  • Preventive and therapeutic dental services
  • Dental education and counseling

Eligibility requirements:
  • Texas resident
  • Income at or below 185% FPL
  • Not eligible for other healthcare programs

Documentation for Family composition (Any of the documents below is accepted)
  • Birth certificate
  • School records
  • Baptismal certificate
  • Proof of family relationship and a copy of lease

Documentation for Income (Any of the documents below is accepted)
  • Copies of most recent paychecks
  • Employer’s written verification of gross monthly income
  • Child support statement
  • Unemployment benefit statement
  • Notes/receipts of cash income

Documentation for Family composition (Any of the documents below is accepted)
  • Texas Driver license
  • Voter registration
  • Rent or utility bill
  • Motor vehicle registration
  • School records
  • Medical cards or another benefit cards
  • Property tax receipt