New Patient Enrollment
Uninsured Adults (19-64 years), living in Cabarrus County, NC may be eligible for free medical and pharmacy services provided by the Community Free Clinic and their partners.
To be eligible you must meet these requirements:
- Be a resident of Cabarrus County
- Be between 19-64 years old
- Have a household income at or below 200% of the federal poverty line
- Have no private health insurance, and do not qualify for Medicare or Medicaid
- Have a chronic illness
How to Apply?
Enrollment hours are cancelled until further notice. All applications and support documents* may be submitted the following ways:
- Email: firstname.lastname@example.org
- Fax: (704) 705-2741
- Mail:528-A Lake Concord Rd. NE, Concord, NC 28025
- Lockbox (located outside front door, street side)
Applications and envelopes are available through the front door, street side of the building.
*COPIES of support documents ONLY as we are unable to return any originals.
What information do I need to provide?
You will need to complete the Patient and Clinic Agreement application, provide proof of address, proof of income, and proof of taxes paid. If you are legally married, be sure to provide all applicable documents for both you and your spouse. Please note that additional documentation may be needed on a case by case basis.
1. Patient and Clinic Agreement Application
2. Proof of Address
- Valid North Carolina driver license with current address
- Government issued ID with current address
- Government issued letter, utility bill or medical bill dated within the last 30 days
- Valid and current lease agreement
3. Proof of Income
Provide all applicable types of income documentation:
- Wages – pay stubs for the last 30 days or income verification form completed by employer: Income Verification Form, Income verification form (Spanish)
- Self-Employed – complete the self-employment form: SELF EMPLOYMENT FORM, SELF EMPLOYMENT FORM (SPANISH)
- Unemployment Benefits – notice of benefits statement
- Supplement Social Security Income (SSSI) – current year benefit letter
- Disability – current year benefit letter
- Pension/Retirement – current year benefit letter
- Receiving financial assistance from friends or family (no other income) – complete the Letter of Support/Zero Income form: Zero Income & Letter of Support, Zero Income & Letter of Support Spanish
4. Proof of taxes paid
- 1040 tax return from prior year.
- If you did not file taxes last year – complete the form: 4506T
We’re here to help, please call us with any questions. We have bi-lingual English and Spanish speaking new enrollment specialists who can assist you.
Phone number: (704)-782-0650