BECOME A PATIENT
HOW TO BECOME A PATIENT
Make sure you're eligible for services (see below)
Arrive at the clinic during our office hours
Bring necessary documents
ELIGIBILITY TO RECEIVE SERVICES
To receive services, a person must meet two criteria:
No health insurance – no Medicare, Medicaid, VA, or private health insurance
As of January 1, 2023, we have increased our eligibility threshold. Household income must be at or below 250% of the Federal Poverty Level.
The 2024 Federal Poverty Level is defined as:
$3,138/month or $37,650/year – 1 person
$4,258/month or $51,100/year – 2 people
$5,379/month or $64,550/year – 3 people
$6,500/month or $78,000/year – 4 people
WHAT DO I NEED TO BRING?
If you do not have your complete financial information, you will be permitted to see the provider for that visit, but no medications from the on-site pharmacy or specialist referrals will be provided until all documentation is received. You will not be permitted to see the provider after that time until all your documentation is received. Documentation will be accepted Monday – Thursday from 8-4 and Friday from 8-11.
Updates to the Verification of No Income Status form and paystubs will be completed every 6 months.
Patient Identification
Picture ID: drivers license, visa, passport, or other state issued ID
Proof of Residence: current utility bill, tax bill, lease, etc.
Social Security
Social Security Number/Card
Proof of Household Income
Employed or receiving an income (including Social Security, disability, workman’s comp, retirement income, etc.)
Most recent federal tax return AND W-2 (Form 1040, 1040A, 1040EZ, 1099).
Proof (i.e. award letter or agency statement) of Social Security, SSI disability, workman’s comp, or retirement income for patient and all adults (18 years old and above) living in household.
Most recent 3 paystubs for patient and 1 paystub each for other working adults (18 years old and above) living in household.
Unemployed
Most recent federal tax return AND W-2 (Form 1040, 1040A, 1040EZ, 1099)