Eligibility
Patient Verification Form Fill online
Confirms you meet the clinic's eligibility and income requirements for no-cost care. Note: the online version does not collect your Social Security Number for your protection.
Fill out our forms online and print them to bring in, or download a blank copy to complete by hand. Completing forms ahead of time helps your visit go faster.
Fill out online and print, or download a blank PDF.
Confirms you meet the clinic's eligibility and income requirements for no-cost care. Note: the online version does not collect your Social Security Number for your protection.
Your contact details, insurance authorization, and a full medical history so our volunteers can care for you safely.
Request medications at no cost. Lists the documents you'll need to bring to qualify (proof of citizenship, utility bill, income confirmation).
New patients: bring a photo ID if you have one, proof of income, and any current medications. Walk-ins are always welcome — no forms required to be seen.
Guidance documents you can read online or download.
Prevention steps for people confirmed to have, or being evaluated for, Covid-19 who are recovering at home — plus guidance for caregivers.
The clinic's screening procedure for Covid-19, applied to all patients, volunteers, and visitors for everyone's safety.
We're happy to help you understand what's needed. Reach out any time, or just walk in — our volunteers can help you complete forms on-site.
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