For Patients

If you fit all the eligibility criteria and would like to become a patient please call the Grace administrative offices at 407.601.4086 ext. 1 to make an eligibility appointment.  At your eligibility appointment you will need to prove your patient eligibility. If you are an existing patient and need to speak with medical staff please call 407.936.2785.

Patient Eligibility

Click here to download Patient Intake Forms – ADULTS.

Click here to download Patient Intake Forms – CHILDREN.

A person interested in becoming a patient at Grace Medical Home must meet all the following eligibility criteria:

Eligibility Criteria Provide Proof through ONE of the Following Documents
Currently living in Orange County for at least 6 months
  • A utility bill
  • Lease or rental contract
Earns less than 200% of the Federal Poverty line  Click here for Current Federal Poverty Guidlines)
  • Pay stubs (last 4 weeks)
  • 1040 (tax return form)
  • W2 (employer-filed wage & tax statement)
  • Letter from employer verifying income
Has been employed at some point within the last six months or is a single parent or is a full-time student
  • Pay stubs (last 4 weeks)
  • Letter from employer verifying employment
  • Letter of Support
  • College ID Card
Uninsured and not eligible for government assisted health care programs (such as Medicaid, Medicare & VA benefits) Patient may be required to sign a form verifying they do not have insurance.


If you cannot keep your appointment, you must call 407.936.2785 to cancel and reschedule.

First appointment – If you do not cancel ahead and do not show up for your first appointment, you will be ineligible to be a patient at Grace.

After your first appointment, if you fail to keep or cancel any appointment at Grace you will receive a warning letter. If you fail to keep or cancel a second time, you will no longer be an established patient.

Patient Contribution

Grace is a not-for-profit and patients are expected to contribute a small facility fee toward the cost of their care.  Arrangements can be made for those who cannot afford to pay.

Grace Medical Home Policies

Grace Medical Home strives to provide excellent health care in a professional environment.  The following guidelines were established to make everyone’s visit to Grace efficient and comfortable.

• Please be early for all scheduled appointments to fill out necessary paperwork.
• No cell phone usage.
• No smoking.
• No bad language.
• Parents must control their children in the waiting room.
• Patients who do not speak English are strongly encouraged to bring an interpreter who is 18 years or older.