Conviértase en Paciente

Eligibilty Requirements

• Patients must be uninsured.
• Patients must be a Rowan County resident.
• Patients cannot have a household income exceeding 200% of the Federal Poverty Level (currently $23,760 for individual and $48,600 for a family of four).

Directions for Application

• Complete the Application For Services and Patient Health History Form. If you are self-employed, you must also complete the Self-Employed Statement of Income Form. These forms can be returned at any time the clinic is open. Incomplete application forms may cause a delay in services. This Eligibility Requirements and Directions For Application Form explains the items to bring to the Enrollment Appointment for verification of eligibility.
• Your application will be reviewed by the clinic staff. Please be sure that you have given a current phone number at which you can be contacted. You should expect to hear from the clinic within 5-7 business days of completing your application. If you are approved, you will be scheduled for an Enrollment Appointment. During the Enrollment Appointment, you will not see a doctor.
• The following information must be brought to the Enrollment Appointment. Copies of the information below will be made and you will complete any other forms needed for your chart. Your paperwork will be processed and you will be enrolled as a patient. Upon completion, your first doctor’s appointment will be scheduled.