You must be a resident of the state of Texas.

Have an annual household income below 300% of the Federal Poverty level for your family’s size.

Have no health insurance

Have a valid prescription for your medication.

Fill out the application

• Type your answers into the fillable PDF, then save the document to your computer.
• You may also download and print the application to complete by hand.

Gather all your documentation:

• Proof of residence
• Proof of income (If you have no income, or someone helps to support you, you can submit the Hardship Referral Letter to meet the proof of income requirement)
• Photo ID
• Prescription

Due to COVID-19, all applications and documentation must be scanned and emailed to enroll@svdpdallas.org

Applications submitted with documents missing are considered incomplete and will not be considered until all information is submitted

No cost for your prescription medications

Medication counseling

Refill reminders

Delivery assistance:

• Potential delivery of medications to clinics
• Mail order delivery