Cost Estimate

At The South Bend Clinic we are committed to providing patients with quality and affordable health care.  As our patient, you have the right to know the cost of your care and request an estimate of the amount you will be charged for your nonemergency medical service that you are provided.  This is a Good Faith Estimate and will be provided to you within five business days upon request.  This estimate is valid for 30 days.

Please click the link and complete the form, providing as much information as possible.  Once your request is completed, and all relevant information has been received, please email and we will generate a personalized good faith estimate based on the information you provided.

If you have any questions regarding your estimate, please call us at 574-299-2450 or email us at

Cost Estimate Form

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