Required Documentation For Registration
In order to verify that a patient meets the eligibility requirements, all patients must register and provide the documentation listed in the checklist. [click for documentation checklist]
Signing Up For Services
The patient’s ID, residency and/or employment, income and resources, unless questionable, is acceptable for the initial visit. The patient will not be seen or assisted again until the required paperwork is provided to the clinic. If it is determined that the patient is eligible for services and completes the required paperwork, a certification of one year will be given. Patient eligibility is subject to review at any time, and it is the responsibility of the patient to inform us if there is a change in his/her status that could affect eligibility.
New Patient & Patient Recertification Forms
Applications are for applying as a new patient or recertifying as an existing patient. Applications are in English and Spanish.
All applications can also be picked up at the Clinic at 918 Greenfield Street in Elizabeth City. If you would like an application mailed to your location, call our clinic and request a mailed application packet.
