Patient Eligibility

Becoming a Patient

New applicants may apply during normal clinic hours.
Applicants should bring proof of income for all members of the household who have income.
Applicants will be screened for eligibility and will fill out a patient information packet.

Applicants will not be given an appointment to be treated unless:

• they meet all of the eligibility criteria, and
• we have received proof of income, and
• we have their patient information packet.

For more information, please contact the receptionist (extension 10) at the clinic's main number.

Eligibility Criteria

In order to be eligible, applicants must meet all of the following criteria:

• Grayson County resident
• adult, or child at least two months old
• not covered by insurance, Medicaid, or Medicare
• does not exceed the gross annual income limit:
• $20,000 for households of one person
• $40,000 for households of two or more people
• Proof of Residency:
• Utility bill
• Phone bill
• Lease agreement

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Proof of Income

In order to comply with requirements for all of our funding sources, all patients must bring complete proof of income for all members of the household who have income. Acceptable proof of income includes, but is not limited to:

• W-2
• disability award letter
• unemployment eligibility letter
• two (2) months' current pay stubs
• most recent income-tax return
• Social Security award letter
• food stamps eligibility letter
• HUD award letter
• verification of employment (on company letterhead)

All proof of income will be verified independently.

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