Patient Eligibility Mini-Screening
Help us determine whether or not you qualify for our services!
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Do you currently live in Aiken County (including Aiken, North Augusta, Wagener, Willliston, New Ellenton, Graniteville, Warrenville, Beech Island, Jackson, Clearwater, Salley, Burnettown, Gloverville, Vaucluse, Windsor, Belvedere, Langley, Perry, Monetta, etc.)?
*
Yes
No
Other
Do you currently have any form of health insurance (such as Medicaid, Medicare, or Veteran's benefits)?
*
Yes
No
Other
Are you at or below 300% of the federal poverty guidelines (approximately $46,950 for a single person, increasing by about $16,500 for each additional household member for 2026)?
Yes
No
Other
What is your age?
*
Do you have any of the following health conditions: obesity, high blood pressure, high cholesterol, asthma, Chronic Obstructive Pulmonary Disease (COPD), diabetes, thyroid conditions or seizure conditions?
*
Yes
No
Other
Check My Eligibility
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