We are committed to make a personal primary care provider available to you who provides for your healthcare needs and helps to coordinate your care across all settings, including the hospital, clinics, testing facilities, and other places where you receive healthcare.
For new patients that meet the eligibility requirements above, click the "Apply Now" button to start your new patient application today!
Amber Martens Director of Eligibility and Community Outreach757-886-0608 (ext 252)email
Pay stubs for ONE monthStatement of ONE month gross earnings from employer (on notarized letterhead).Note: Must be most current month
Schedule C included with Tax Transcript (1040)Notarized copy of Daily Earnings Statement Worksheet.Note: Daily Earnings Statement Worksheet and Notary available at clinic
Notarized Support Letter from supporter stating financial circumstances of patient. Supporter must provide their current proof of income, current proof of address and a copy of signed tax return (1040).Note: Support Letters and Notary available at clinic
Unemployment Benefits award letter from Unemployment Commission
Award letters from any of the following: Social Security, Disability, Retirement/Pension, Food Stamps, TANF, Housing Assistance (HUD).Note: Must be most current statement
Copy of court order (if available)