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New Patient Information & Policies

Learn about eligibility, documents, and appointment policies for free services at Hope Medical Dental Clinic.

Welcoming New Patients

Hope Medical Dental Clinic does NOT provide emergency services. If you have a medical emergency, please call 911 or visit the nearest emergency room.

We offer FREE, non-emergency medical and dental services to uninsured Delaware residents over the age of 18, with income at or below 300% of the Federal Poverty Guideline.

Services are provided by volunteer medical and dental professionals in a private, clinic-based setting. Appointments only—no walk-ins accepted.

Please click on the images on the right to download each document. If you are unable to fill out the documents before your appointment, please arrive15 minutes early.

New Patient Registration Form

 Download

Health Information Consent Form

 Download

Missed Appointment Agreement

 Download

Patient Eligibility

Patients must pass the following criteria to receive services.

  • Patient must be 18 years or older and have proof of residence in Delaware.

  • Patients must have no insurance, Medicaid, or Medicare for the service needed (e.g. If you have medical insurance without dental insurance, you may qualify for dental care).

  • Patients must have income at or below 300% of Federal Poverty Guidlines.

Preparing for Your Visit

Please bring the following documents to complete your application.

  • Valid/not expired ID.

  • Proof of Delaware residency (utility bill, phone bill, lease agreement, etc. with your name on it. If you live in a shelter, bring a letter confirming you live there).

  • Pay stubs, SNAP benefits, SSI benefits, unemployment benefits.

  • If you have no income, bring your most recent federal tax return.

  • Medicaid denial letter dated within the past 6 months.

If You Are Unemployed

We will accept any of the following as proof of income:

  • Valid/not expired ID.

  • Current SSI benefits letter.

  • Retirement/pension letter.

  • Veterans' benefit letter.​

  • Unemployment statement.

  • Proof of child support for each child.

  • TANF letter.

  • DHHS statement.

  • Other household income.

If You Are Supported by Someone Else

If you live with someone who supports your needs:

  • That person must sign the last page of your application

  • Provide a bill with their name and address as proof of residency

Policy on Cancellations, No Shows, and Lateness

As a courtesy to our staff, volunteers, and other patients, please call if you are running late. If you need assistance with transportation, let us know--we are here to help! ​

Please call at least 24 hours in advance if you need to reschedule or cancel your appointment. We will gladly help you reschedule. ​

If you do not show up to your appointment, you will be considered a "no show." If you have 3 no shows, you will be ineligible for services for 12 months.