Do I Qualify?
Building a healthier community, one checkup at a time!
You’re eligible for care if you:
Are uninsured
Reside in Mecklenburg County or the southern section of Iredell County (zip codes 28115 and 28117)
Earn up to 250% of the federal poverty level as a household
Eligibility Screenings
Please note that eligibility screenings for prospective patients are required before scheduling an appointment.
Eligibility screening appointments are available:
- Tuesday and Thursday: 8 am – 4 pm
- Wednesday: 11:30 am – 4:30 pm
To make an appointment for your screening, call 704.316.6611. This process is only required for first-time patients or current patients who’ve been asked to renew their eligibility status.
What to Bring to Your Screening
- Photo ID: driver’s license, passport, or foreign ID
- Proof of address proving residency in the areas we serve. Accepted documents include:
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- Utility bill (gas, water, or electricity)
- School form
- Medical bill
- Rental/lease agreement*
- Last year’s tax return
- Proof of income from every working member of the household for the last month: four pay stubs if you are paid weekly or two if you are paid every two weeks*
- Documentation of all other forms of income: Social Security benefits, unemployment, pension, child support, alimony, and all other sources of income.
- Food stamps or food stamp letter
- Two most recent bank statements
*If you are unable to provide proof of residency or income, you must complete the related form(s) below and bring them to your eligibility screening appointment.
Forms You May Need for Your Eligibility Screening
- Documentation of Address Form: If you don’t have proof of address in your name, please complete this form and provide the necessary documents listed on the form.
- Documentation of Support Form: If someone provides all or some of your living expenses (food, housing, utilities, etc.), ask that provider to complete this form and include the documents listed on the form.
- Statement of Income Form: If you do NOT receive pay stubs from your employer, please ask your employer to fill out this form.
- Self Declaration of Income Form: If you are self-employed, please complete this form and ask a witness to sign it.
- Dental Patient Application: Please complete this form if you have medical insurance but not dental insurance and need dental care.
*If you are unable to print these forms at home, you can visit the clinic during operating hours to pick up a copy.
