services

Assistance Required (Self-referral)

By completing this form, you are requesting a representative from Good Shepherd Clinic to contact you and assist as they are able.  We will contact you within two business days.  The information you enter is completely confidential and there is no cost for this serve.  Please use this form to request services for those who are between the ages of 19-64 and have no medical or dental insurance.  Consent submitted through this form should be signed by the person who would be receiving services.