To download an Eligibility form, click on the links below, or visit the Forms tab for more information. Eligibility forms are also available in the Eligibility office.

Eligibility Application

Aplicación de Eligibilidad

To receive services at San José Clinic, low-income, uninsured individuals and families must first complete an eligibility interview. Those that qualify for services will receive a patient account, providing them access to services.

Eligibility interviews are conducted on a walk-in basis from 8 a.m. to 4 p.m. Monday through Friday. No appointment is necessary.

You must bring identification, proof of income and proof of address to your eligibility interview. Examples of these are outlined below.

Please bring:

Adult - bring one of the following for each adult (ID must include photo):
-Texas Driver's License
-Texas Identification Card (current or expired)
-Passport, Visa or ID from another country
-U.S. Immigration documents
Child - bring one of the following for each child:
-Birth Certificate
-Birth Fact Record
Note: A Social Security card is not required; however please bring one for each family member that has one.

Bring as many of these documents as you have
-Last 4 paycheck stubs (or 2 stubs if paid bi-weekly) or wage verification letter.
-Welfare benefit documents (TANF and Food Stamps)
-SSI or Social Security certification documents
-Unemployment documentation
-Child Support
-Most recent tax return

Bring documentation showing where you have lived for the past month.
-Utility Bill
-House or Lease Payment
-Medicaid Document
Please feel free to call 713-490-2610 if you have any questions.