Client Enrollment

Updated Enrollment Form

An updated version of the Enrollment Form is now active. Please start using it March 9, 2026.

This page has resources and tools to help clinic staff with the client enrollment process. Click the jump links below to get to specific sections of the page:

Enrollment Form
Trainings
CCare Corner
Eligibility Database
Eligibility Verification and Notice of Eligibility
Notice of Privacy Practices and Voter Registration,

Enrollment Tools Table

RH Access Fund Enrollment Form

To enroll in the RH Access Fund, clients must complete the RH Access Fund Enrollment Form. Use the links below to print the form in any of the available languages, or to have the client complete the form electronically.

English	Spanish
Korean	Marshallese
Russian	Simplified Chinese
Vietnamese	Somali

For instructions on how the Enrollment Form should be completed see our Enrollment Form Guide.

For guidance on how to enroll a client who is not in the clinic see our Remote Enrollment Guidance.

To order more printed Enrollment Forms for your clinic, please complete this Order Form.

Training

Client Enrollment Process (updated March 2026)

Learn more about the enrollment form and process as well as how to use the eligibility database. This training is for RHCare, CCare, and AbortionCare Clinics. Following the training, take the short Test Your Knowledge quiz. This can be accessed via the QR code at the end of the training or by following the link listed on the slide.

Video | Slides (with clickable links)

Eligibility Database

All client enrollment data, from the Enrollment Form, must be entered and saved in the Eligibility Database for the client to be considered fully enrolled.

Eligibility Database Instructions (includes screenshots)

To gain access to the Eligibility Database, complete and submit one of the two forms below:

Ahlers User ID/Password for agencies with 1-9 clinics

Ahlers User ID/Password for agencies with 10 or more clinics

Eligibility Verification

The RH Program verifies the income and the citizenship status of enrollees who mark U.S. Citizen on the Enrollment Form. The resources below help clinic staff understand the verification processes and what they can do to help enrollees.

Eligibility Status Update Guide: describes the monthly status update email. Includes samples, describes what is included, and what action clinic staff should take.

Notice of Eligibility

Enrollees must be provided a Notice of Eligibility (NOE). See the guidance document, and different versions of the NOE below.

NOE Guidance

Hand-fillable English | Spanish

Form-fillable English | Spanish

Half and half English | Spanish

CCare Corner

Enrollment Form Cover Page

This cover page tells clients what services they can get at a CCare clinic, and where they can get additional services offered at RHCare clinics. CCare clinics should add local RHCare clinic locations at the bottom of the page.

English

Spanish

Simplified Chinese

Korean

Marshallese

Russian

Vietnamese

Tip Sheet

A quick-look resource for common eligibility and billing questions around insurance coverage, income, and citizenship requirements. Click the link below and post it at the front desk and billing for easy reference!

Eligibility & Billing Tip Sheet