For eligibility interviews, please print, complete and bring the eligibility application to your eligibility interview.
Wage Verification Letter
A completed wage verification letter can be used in place of presenting a month's worth of recent paycheck stubs.
Statement of Support
A completed statement of support can be used in place of presenting a month's worth of recent paycheck stubs, if you are being financially supported by someone besides yourself or your spouse.
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
- Entrega de Historial Médico
- Dental Records Release Form
- Entrega de la Historia Dental