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
Charitable Eligibility Requirements-
- Resides in Wake, Nash, Franklin, or Johnston counties
- Has a chronic disease
- Is uninsured
- Is at or below the 200% poverty level
We also accept Medicaid & Medicare! Those who have an income over 200% the Federal Poverty Level will pay based on a sliding scale.