New Patients

in order to qualify for our services you must be a current resident of Allegan county, as well as being 200% or below poverty level (reference the chart below if you are unsure if you fall within this category). We hope to expand our services to allow our patient base to grow, if you have any suggestions feel free to e-mail us at or call/text 269-358-8839!
Poverty level chart

To Sign up for an appointment to see a mental health, or medical professional please do not hesitate to call us at (269)355-3053 Monday or Thursday 9-5.

As a new patient, it would greatly expedite your registration process if you could please remember to bring the following items to your first appointment:

Medical records/prior

  • Identification
  • Income/Taxes
  • List of current medications

Although we have extra copies at the clinic, it would be greatly appreciated if you could fill these out and bring them to your first appointment.

New Patient Insurance Information Form

Patient Demographics Form

Patient responsibility

Renewed Hope HIPPA 2013

Renewed Hope Permission form for new patients