Thank you for your interest in becoming a Volusia Free Clinic New Patient!

Please click the button below to download the paperwork needed to register with our clinic. If you can, complete the paperwork and send it back to Manager@VolusiaFreeClinic.com or fax it to 386-220-9871. If you have technical issues or questions about how to complete the forms, please call our office.

We will contact you soon to follow up after receiving your forms. If you are unable to complete the paperwork for any reason, please email us and we can arrange for you to come to the office and fill out the paperwork in person. Sending it in electronically will speed up the process, of course. Please call 386-316-2771 for more information. THANK YOU !