We are so excited that you want to partner with us for the betterment of your health! Please fill out the forms below before your appointment. This will help keep your appointment on time.

Form in English

Form in Spanish

What does "at or below 200%" mean?

Our government uses the Federal Poverty Guidelines to determine eligibility to certain programs. The official Federal Poverty Level is considered to be "100%" (Office of the Assistant Secretary for Planning and Evaluation). This means that our guidelines allow you and your family to be twice that level. The graph on the right demonstrates the maximum yearly and monthly income you can have to qualify for care at our clinic.
Source Found Here

What is a "chronic disease"?

A chronic disease needs continual care and lasts more than a year. There are many different types of chronic disease, including diabetes, asthma, and hypertension (Centers for Disease Control and Prevention). Our health care workers are here to provide a care plan and routine checkups for you.
Source Found Here

Income Table for North Carolina

# in Household 200% of Annual Income 200% of Monthly Income
2 $34,840 $2,903
4$53,000 $4,417
6$71,160 $5,930

Please contact us to apply or for more information!