Care Connection

"*" indicates required fields

If you are in crisis STOP. Call 911 or our Emergency Services Department at 239-275-4242.

How can SalusCare Help? (Please select all the below statements that apply to you.)

Section 1

Address*
Mailing Address

Section 2

Date of Birth*
Do You Require a Translator?
Please type detailed information about any allergies you may have

Section 3

Emergency Contact Address
Legal Guardian Contact Address

Section 4

Do you currently have health insurance?
Are you registered to vote?

SalusCare, Inc. Corporate HQ
3763 Evans Ave.
Fort Myers, FL 33901
Monday-Friday | 8:00am - 5:00pm
Get Directions


Stay Up To Date With SalusCare

Give a Gift. Save a Life.
Donate Today ›

Your tax-deductible donation to SalusCare will help put hope and recovery within reach for those in need.

Pay My Bill Now