Screening Documents & New Patient Forms
Required - Bring the following documents to your screening appointment:
I.D. (driver’s license, passport, etc.)
Insurance cards
Financial information - one of three things:
3 most recent months of paystubs
Tax 1040 form
Social Security Letter
If you do not have any income, your screener will prepare a Letter of Support and a Declaration of Income/No Income. If you are self-employed, a Declaration of Income will be prepared. After these forms are filled out, they will be notarized.
If you have a spouse (a partner you are legally married to), you need to bring their financial information as well. Even if they are not a patient or don’t plan to become a patient, your Federal Poverty Level (FPL) is based on your income and household size. This means all income supporting the household needs to be documented.
Optional - Fill out the following online forms before your appointment:
While filling out forms before your appointment is not necessary, it ensures you are ready for your appointment.
Please note that your screening appointment will take longer (close to 60 minutes) if you do not fill out forms in advance.