These services were specifically designed for Polk or Burnett County resident only that falls within our income criteria. Please follow these simple steps to take advantage of these free services:

  1. Contact us at (715) 472-7770 to schedule your appointment.
  2. If you have not visited the Well Care Clinic before, complete the Ruby’s Well Care application.
  3. Submit application and await approval (takes 4-6 days).
  4. Upon approval, we will confirm your appointment time.

 

 

Items Needed for the Well Care Application

HEALTH HISTORY

  1. List of names and contact numbers of physicians, clinics, and hospitals that have treated you in the past 2 years.
  2. List of Current Medications which includes dose and frequency.
  3. Medications you are allergic to and the reaction you experience.
  4. List of over-the-counter or herbal medications you take regularly.
  5. List of previous hospitalizations and surgeries (and dates if available).

 

PROOF OF IDENTITY  ( ONE OF THE FOLLOWING):

  1. Passport
  2. Picture ID
  3. Other Nationality Picture ID

If your picture identification does not have the current address also bring a recent utility bill with name on it or mail us with your current postal date and name on it.

 

MONTHLY INCOME ESTIMATE

This information will be used to determine if you qualify for other services and will not affect your eligibility to receive health services from Ruby’s Well Care.  Our health care providers can provide information on other low to free services in the area.

 

PROOF OF ADDRESS (ONE OF THE FOLLOWING):

  1. Recent utility bill with your name on it.
  2. Mail with current postal date and your name on it.
  3. If living in a shelter or treatment facility, provide a letter from them stating that he/she is staying at their facility.