Applying

If you are interested in applying to become of patient and meet the eligibility requirements, you must complete an application. Applications are available during office hours at our reception desk.

The application process usually takes anywhere from 3 - 4 weeks. We can try to accommodate referrals and urgent needs.

Providing all the following items in a timely fashion will expedite the process:

• Copies of last month's income for everyone who is working in the household. The following items may be used:
• Pay stubs (2 or 3 would be best)
• Social Security benefits letter
• Unemployment check/letter
• Disability statement
• Pension statement
• Copies of your last U.S. 1040 Federal tax statement for everyone who filed in the household (note: W-2s will not suffice)
• Copy of a picture I.D.
• Copy of a piece of mail for residence verification (examples: utility or credit card bill)
• $20 application fee

Note: If you do not work, you must provide proof or explanation of other income. If someone else is supporting you or you live with them, their proof of income is required. If your income is zero, you will be asked how you are living. Be prepared to answer that question.