ELIGIBILITY APPLICATION

For eligibility interviews, please print, complete and bring the eligibility application to your eligibility interview.

• Eligibility Application
• Aplicación para eligibilidad

WAGE VERIFICATION LETTER

A completed wage verification letter can be used in place of presenting a months worth of recent paycheck stubs.

• Wage Verification Letter
• Carta de verificación de salario

Medical Records Release

For a copy of your medical records, please print, complete and bring or mail the medical records release form to the Clinic.

• Medical Records Release Form
• Registros Médicos de lanzamiento