New Patient Enrollment
The clinic works to serve those dealing with chronic illnesses who have no alternative health care resources. Qualified patients living within Cabarrus County, NC may be eligible for free medical, pharmacy and dental 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 at least 19 years old
- Have a chronic illness
- Have a household income at or below 125% of the federal poverty line – review the federal guidelines
- Have no private health insurance, and do not qualify for Medicare or Medicaid
How to Apply?
You can mail your application documents to the clinic or bring them in person during our HealthNet enrollment hours. The clinic has a team of specialists, including bi-lingual English and Spanish speaking specialists, who are available to assist you in person 3 days a week.
HealthNet enrollment hours:
Tuesdays: 9-11 AM
Wednesday: 1-3 PM
Thursday 9-11 AM
Please note you must apply to the MedAssist pharmacy program separately. The clinic will forward all patient information from the HealthNet clinic application to MedAssist, but patients are responsible for completing their own MedAssist applications.
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’re 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