Eligibility For Free Care
The Albrecht Free Clinic is proud to offer free medical care to qualifying individuals. To qualify for services, individuals must:
- Live or work in Washington County
- Have no insurance coverage
- Have a household* income at or below 200% of the Federal Poverty guidelines
*A household is considered yourself, your spouse, and children that reside in the same house as you.
Application Process
If you meet the above requirements, we encourage you to apply. Here’s how:
- Print and complete the following form:
Patient Application - English | Patient Application - Español/Spanish - Provide proof of address* or employment in Washington County. The following are acceptable documents:
- Current WI Drivers license or WI ID card with current address
- Utility statement with current address
- Rental agreement
- Paycheck stub with employers name and address
*If you are currently without a home, you may still apply if you provide a signed letter from the person currently providing you shelter, along with proof of their address.
This can be a family member, friend, or shelter facility. - Provide income documentation. The following are acceptable documents:
- Paycheck stubs showing one month’s worth of consecutive income for each working individual in the household
- Social Security letter stating monthly benefits
- Unemployment
- Self-employment/tax return
- Pension/retirement
- Once application is complete and you have copies of your proof documents, you can mail to or drop off at 908 W. Washington St., West Bend, WI, 53095, fax it to (262) 306-7717, or email it to contact@albrechtfreeclinic.org.
- Upon submission of a completed application and income documentation, the information will be reviewed and a decision made regarding your eligibility for services. If you are eligible for services and you present during an evening clinic time, you may be seen during the evening clinic or schedule an appointment for a different time.
