How to Become a Patient:
We require all of our patients to come to the Clinic for a financial eligibility screening prior to receiving an appointment. Screenings are held Mondays between 11 am and 1 pm and Wednesday evenings between 5 pm and 7 pm.
This applies to first-time applicants and current patients who need to renew their eligibility status. To schedule an appointment, please call us at (704) 316-6611.
We serve all of Mecklenburg County and the southern section of Iredell County (zip codes 28115, 28117). Most patients reside in zip codes 28036, 28031, 28078, 28214, 28216, 28262, and 28269.
We are accepting new patients with a household income up to 200% of the federal poverty level. Click here for the income chart.
What to bring to your eligibility screening:
1. Picture ID, driver’s license, or passport
2. Two documents proving residency in the areas we serve. Acceptable documents include: utility bill, school form, medical bill, or lease/rent.
3. All proofs of household income, such as most recent pay stubs
4. Current tax return, unemployment benefits statement, workman’s compensation letter, VA benefit, pension/retirement, alimony, child support, rental income and all other forms of income
5. Food stamps
6. Two most recent bank statements
A fifteen dollar donation by cash, credit or debit is requested for each appointment and for the eligibility screening to help cover administrative costs. All medical services are provided at no cost.
Forms for screening:
– Patients that have living expenses provided for them or do not have any way to show proof of address, must have their provider fill out and sign the documentation of support form and the documentation of address form to bring to screening.
– Patients who are self-employed must complete the self declaration of income form have a witness sign it, and bring it to the screening.
– Patients who do not receive pay stubs from their employer must have their employer fill out the statement of income form and bring the completed form to your financial screening appointment.