A ten dollar donation is requested for each appointment and for the eligibility screening to help cover the cost of operating the clinic. All medical services are provide at no cost. Patients should bring all medication to every appointment.  


Patient Requirements: 

You must have a financial screening prior to seeing a physician.

Screenings are conducted on:
Mondays between 11:00am-1:00pm
Wednesdays between 5:00pm- 7:00pm


If you do not speak English, please bring an interpreter that is at least 18 years of age.


What to bring to screening:

We serve the following zipcodes:  28269, 28216, 28031, 28036, 28078, 28115, & 28117

- Picture Id and one of the following if it applies to you: Social Security Card or ITIN Card and/or green card

- 2 Documents proving residency in one of the above zip codes

     Examples: Driver's License, School Document, Bank Statement, Car Insurance, Utility Bills    

- Bring all forms of income

     VA Benefits, Pension, Retirement, Alimony, Child Support, Rental Income,         
     Food Stamps, Two Consecutive Paystubs & Letter Proving Unemployment Benefits

Forms for screenings:


Patients that have living expenses provided for them must have their provider fill out and sign the following form to bring to the screening:

For Patient Having Living Expenses Provided for Them.doc

Patients who do not have any way to show proof of address (see proof of address above) must complete the following form and bring it to the screening:

Certification of Patient Address Form.doc

Patients who have no income must complete the following form and have a witness sign it and bring it with you to your financial screening appointment.

No Income Form.doc

Patients who do not receive pay stubs from their employer must have their employer fill out the following form and bring the completed form to your financial screening appointment.

Employment Statement of Income.doc

Health Opportunities


In order to better fulfill our mission to improve the overall health of our patients in our community, we will begin offering health education clasess. To sign up for one of these opportunities, please call or visit our front desk.

Weight management class: This class is designed to provide you with one on one counseling to help loose weight. If you have a body mass index of over 30, you are at greater risk for cancer, along with many other health issues. If you have been looking for a way to help shed some pounds, please sign up for this class. It will change you life!


Diabetes Education: If you or someone you love have been diagnosed with diabetes, this class is for you. Learn more about the disease, what your diet should consist of, and options for keeping this disease under control.