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 8 pm.
Please note: For your convenience, we now schedule appointments for eligibility screenings. 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. Screenings are held Mondays (11am – 1pm) and Wednesdays (5pm – 8pm).
We serve all of Mecklenburg County and the southern section of Iredell County. The majority of our patients reside in these zip codes: 28117, 28115, 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 2017 Federal Poverty Level Chart.
What to bring to your eligibility screening:
1. Picture ID
2. Two documents proving residency in the area we serve. Acceptable documents include but are not limited to the following: a valid drivers license, utility bill, voting registration card, school form or district letter.
3. All proofs of household income, such as two most recent pay stubs, current tax return or W2 form for the self employed, unemployment benefits statement
All patients are now asked to bring your two most recent bank statements. We now require a bank statement in addition to all proofs of household income to ensure financial eligibility.
4. Forms for screening (if applicable) are linked below
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.