Need Medical Care? Let's See if We Can Help!
Thank for your interest in being our patient!
We are committed to providing high quality health care to people who are low income and who are uninsured or on Medicaid. We need some information from you to see if you meet our income requirements and to connect you to medications and other services to help you thrive. We serve residents of the City of Winchester and Clarke and Frederick Counties.
We have increased our enrollment hours to Monday through Friday 9am to 3pm. But, if possible, we strongly encourage you to apply online.
#1: Photo ID
We need some ID. This can include a drivers license, passport, jail ID, or any other governement-issued identification.
#2: Proof of Virginia Residency
We need a document with your name, address, and a date on it. This can include:
- Virginia driver’s license or state ID with your current address on it
- Apartment or house lease
- Mortgage or insurance statements
- Recent utility bill
- Letter from a shelter or freind/family member where you are staying that includes a phone number
#3 Proof of Income
We need to know how much you made in at least the last month. If you get paychecks, we need your last month’s paystubs. We can also accept a 1040C tax form. Please bring award letters for unemployment benefits, social security, disability or other forms of income. We’ll need these for your whole household (so, for you and your kids who are living with you and who are counted as dependents on your taxes if you do taxes.)
Other Application Items
These documents help us get you access to more low-cost medicines and to complete your financial assistance application with Valley Health:
- Two months of bank statements (if you have an account- these are for Valley Health)
- Social Security Card or ITIN Card or letter
- Tax return
Accepted Proof of Income Documents:
Bring any that apply to your income source
- Pay stubs for 1 month
- Statement of 1 month’s gross earnings from employer (on letterhead)
(Most current or current, 1 month or 30 days pay stubs)
- Unemployment Benefits award letter from Unemployment Commission
- Schedule C included with Tax Return (1040)
- Notarized copy of Daily Earnings Statement Worksheet
(Daily Earnings Statement Worksheet and Notary available on site)
- Information about how you meet your needs, e.g. food, housing, etc.
- Award letters from any of the following: Social Security, Disability, Retirement/Pension, Food Stamps, Housing Assistance
(Must be most current statement)
- Copy of court order (if available)