Patient Requirements

 The following items are required to establish your eligibility.  If you have any form of health insurance you are not eligible for services.

1.  A Picture ID.  You must be over 18 years of age to qualify for our services.

2.  If you are working, we need your last 4 of your paystubs.  We will make copies and return them to you.

3.  If you are receiving any income from Unemployment, Disability, Social Security, Food Stamps, Spousal or Child Support, we will need the Statement of Income from the agency.

4.  If anyone is helping you pay your bills, providing you with food, a place to live and/or cash, you will need to fill out the "Letter of Support".

5.  We need last year's income tax return with the w-2 or 1099, Schedule C or K-1 that you submitted with it.

6.  Completed clinic eligibility Packet

7. If you are a Medicare recipient Part A only you can qualify

Screening is done on Monday afternoon by appointment.  Please let us know if you are working during those hours and we will try to make other arrangements.