You will have to complete the new patient clinic application (attached below) and meet our eligibility requirements prior to scheduling an appointment with a doctor.
Eligibility Requirements (you must):
- Be between the ages 0- 64 ( Above 64 if you have medicare part A only or have no insurance)
- Have no health insurance
- Have an income level that falls within 250% of the Federal Poverty Level based on the number of people in your household
After eligibility requirements have been met, you will be scheduled to see a provider.Patients must re-qualify every year.
1. Identification Documents (any one of the following):
- Driver’s license
- DMV ID card
- Valid Green Card
2. Proof of Income for each working member of your household:
(Choose documents as applicable)
- If patient is employed, then we need a copy of their paycheck stub (last 4 weeks) or letter from employer.
- If patient is self employed, then we need copy of their most recent tax return.
- If patient is unemployed, then we need letter of support from whomever is supporting them. For example, information about the person who is feeding and giving shelter them. We need that information from the person him/herself. See attached letter of support form.
- Child support, Alimony, Food Stamps, SSI
Chart for income guidelines
|House hold size||Weekly income||Monthly income||Annual|
|Each additional person||$193||$838||$10,050|
You can complete all applications and upload required documents electronically through our HIPPA compliant and secure website form submission.
Our address is: 1092 Johnnie Dodds, Blvd., Suite 108, Mt Pleasant, SC 29464
Our fax number is: 843-375-9063
If you have any questions feel free to call us at 843-352-4580