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 to finalize your application.

 

• 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—either for myself or on behalf of the patient—that the information provided in this application is complete and true to the best of my knowledge and belief. I understand that it is my responsibility to notify the clinic of any changes in financial circumstances or insurance status. I authorize the clinic to verify income through the Department of Social Services, the Social Security Administration, my employer, the Veterans Administration, and any other organization from which I receive income. I further authorize Volunteers in Medicine Clinic Hilton Head Island to share this information with auditors or pharmaceutical assistance programs as needed.