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New Patient Requirements

NEW PATIENT ASSessment Process

In order to make sure we serve the intended population, new patients will be screened for eligibility prior to appointment. Please follow the following steps to begin the process of becoming a new patient at the St. Paul Medical Clinic.
Download and complete the Intake Assessment Form.
Type the required information in the PDF form and save on your computer or fill out printed form by hand and scan or take photos of the completed form.
Gather documentation required for proof of  eligibility.
Three separate types of documents must be submitted, one from each category below. Examples of accepted documents are included on the first page of the Intake Assessment Form.
  • Proof of Identity
    Any Identification with the patient’s name and photo
  • Residence Verification
    Any Mail in the patient’s name with their current address
  • Income Documentation
    Proof of Income which covers your monthly expenses, and shows you earn at or less than 300% of the Federal Poverty Level for your household size
Complete the Hardship Referral Form, if needed.
Please submit the Hardship Referral Form (included on Page 4 of the Intake Assessment Form) with your New Patient paperwork if someone besides your spouse supports you by providing housing or paying for your expenses. This letter must be completed by the individual or organization who provides support for you.
Submit all required documentation to the St. Paul Medical Clinic
Attach all required documentation to an email and submit to [email protected].
– OR –
Fax all documents to (945) 279-6751
  • Intake Assessment Form
  • Proof of Identity
  • Residence Verification
  • Income Documentation
  • Hardship Referral Form (if needed)
Speak to a representative of the St. PauL Medical Clinic to complete the assessment process
After your paperwork is submitted, a member of the St. Paul Medical clinic will reach out to you to schedule a phone interview to review your paperwork and complete the new patient assessment process.
Once you are approved as a patient, you may then visit the website to submit an appointment request.

Printable Forms and Resources

New Patient Intake Form
Printable new patient intake form to complete and submit to clinic
Patient Referral Form
For use by hospitals, doctor's offices or other agencies
Income Qualifications
Printable reference with income qualifications


The chart below shows the National Federal Poverty Level for 2023. (Source: St. Paul Medical Clinic is able to serve residents of Texas whose income is less than 3x the Federal Poverty Level for their household size.

Family Size
1 $43,740
2 $59,160
3 $74,580
4 $90,000
5 $105,420
6 $120,840
7 $136,260
8 $151,680

If you aren’t sure whether your income qualifies, you have no income, or you have questions, call the clinic at (945) 279-6750 or email the clinic at [email protected].