Community Clinic Application

Please bring your completed application (download link below) and all supporting documents to the Main Office at 740 E Tenth Avenue in Bowling Green, Ky. For more information, contact the Main Office at 270-781-9260.

Once your application is approved, physician visits will take place at Med Center Health Primary Care located in the Medical Arts Building on the campus of The Medical Center at Bowling Green.

How Do You Qualify for Services at Community Clinic ?

COMMUNITY CLINIC (Medical Services)

• If you are uninsured, meaning you do not have Medicaid, Medicare or any other private medical health coverage AND
• You have applied and been denied coverage through Kentucky Medicaid AND
• You live in one of the following Kentucky counties: Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe,  Simpson or Warren*  AND
• Your family income is at, or below, the amount listed for the size of your family in the chart below,

You qualify for our services! Please print and complete application completely and bring it with Medicaid denial letter and proof of current income (1040 tax form, or at least 2 paycheck stubs, or cancelled checks paid to you from your employer to the Community Clinic Main Office at 740 E Tenth Street, Bowling Green, KY 42101. You may email to Freeclinic@chc.net.