Determining Your Financial Eligibility

To determine your financial eligibility for Volunteers in Medicine we need to know your income and your household size. The number in your household should include:

• Yourself
• Your partner even if you are not married
• Children that live with you
• Other relatives that live with you that share expenses

If you have 6 or more people in your household, you will need to make an appointment to apply in person

• Copy of Photo ID if not already on file
• Proof of address (can be a piece of mail addressed to you, government issued ID or if nothing is in your name - a statement of temporary housing)
• Proof of income from all members of your household dated within the last 6 months.
• Accepted proof of income:
  • 1 month of paystubs or similar payroll receipt
  • An employer verification form signed by employer
  • Statement of self-employment
  • Proof of any disability income, unemployment insurance, alimony or similar
  • Statement of support if your household income is less than 100% of the FPL
  • Signed application(s) from all household members who are applying for eligibility

You can bring the above information to our screening office at 20 Palmetto Parkway, Suite A

OR

You can upload it through our secure link here

• Services are offered voluntarily and without charge.
• The clinic does not bill patients or insurance and is not responsible for costs incurred outside the clinic (e.g., prescriptions, referrals, or specialized tests)
• Care may be provided by licensed volunteers, including doctors, nurses, and other healthcare professionals, as well as supervised medical students or trainees
• We are not an emergency care clinic. If you experience a medical emergency, please go to the nearest hospital of emergency clinic
• As a patient, you consent to a wide range of medical services provided by the clinic, including primary care, preventative care, diagnostic testing, and treatment of minor injuries or illnesses.
• This consent is ongoing for all services provided unless revoked in writing.

I certify that the information I have provided in my application is complete, and true to the best of my knowledge and belief. I further understand that it is my responsibility to notify the clinic of any changes in my financial situation or insurance status. I give permission to verify my income through the Department of Social Services, Social Security Administration, my employer, Veterans Administration and any other company, business, or organization from which I receive income. By signing the enclosed application, I authorize representatives of Volunteers in Medicine Clinic Hilton Head Island to share this information with auditors or pharmaceutical companies as required.