Eligibility

To become a patient of the Free Medical Clinic you must participate in our eligibility screening.

Eligibility for new patients is on Monday and Wednesday from 1:30pm-3pm

Re-certifications can be completed between 9 AM and 4 PM Monday through Friday at the front desk or medication pick-up window as long as you have a completed and signed application, consent form, and have all of the required documents

Eligibility Requirements:

  • Resident of Winchester, Frederick County or Clarke County, VA
  • No medical insurance
  • Income at or below 200% of Federal Poverty Level
  • Not eligible for FAMIS, Medicare, Medicaid, or receive VA benefits

What to Bring:

  • Photo ID, Driver’s License, Passport
  • Social Security Card (ITIN if undocumented)
  • Proof of Residence: Utility Bill, Car or Voter Registration, Lease Agreement, Phone Bill, Cable Bill (bring one)
  • Copy of most recent signed tax return (1040)
  • If taxes were not filed a 4506-T will be required to be signed at the clinic
  • Current Medicaid Denial Letter (if applied or denied)
  • Most recent Proof of Income for each family member that contributes to household income.
    (Accepted documents shown below)

Accepted Proof of Income Documents:

Bring any that apply to your income source

Regular Employment
• 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)

Self-Employment
• Schedule C included with Tax Return (1040)
• Notarized copy of Daily Earnings Statement Worksheet
(Daily Earnings Statement Worksheet and Notary available on site)

Unemployment
• Unemployment Benefits award letter from Unemployment Commission

Zero Income
• Notarized Support Letter from supporter stating financial circumstances of patient
(Support Letters and Notary available on site)

Benefits/Assistance
• Award letters from any of the following: Social Security, Disability, Retirement/Pension, Food Stamps, Housing Assistance
(Must be most current statement)

Child Support/Alimony
• Copy of court order (if available)