REQUEST AN APPOINTMENT

STEP 1: ELIGIBILITY REQUIREMENTS

Written eligibility documentation is required before becoming a patient of the Volusia Free Clinic. If you are eligible, we will inform you of the information that you will need to bring with you to your appointment.

HERE IS A LIST OF THE MAIN ELIGIBILITY REQUIREMENTS FOR NEW PATIENTS:

  • Patients Must Not currently be covered by any Health Insurance, including Medicaid or Medicare or private insurance.

  • Residence: Patients Must be a resident of Volusia County, possess a permanent street address for at least six months, and must be able to demonstrate permanent residence in Volusia County, FL, such as ID, Driver License, Utility Bill, or similar.

  • Age: Patients must be between the ages of 18-64

  • Income: Patients must have income below 300% of the current Federal Poverty Guidelines. Please use the chart below to determine your eligibility based on family size. Currently, that is approx $45,000/yr for an individual or $61,000 for a couple.

Persons in Family/Household

300% Poverty Guideline

1

2

3

4

5

$109,740

$93,600

$77,460

$45,180

$61,320

7

6

8

$125,880

$142,020

$158,160

For each additional person, add $16,140.

BY CLICKING BELOW, YOU CONFIRM THAT YOU ARE ELIGIBLE BASED ON THE REQUIREMENTS ABOVE. You will be taken to the form that you need to complete to become a patient. Please follow the instructions with the form, and you can either download and return the completed form to us, or you can send us your contact information and we can mail you a paper copy of the forms if you do not have access to download and printing capabilities. We can then help arrange an appointment for you if you quality. If you need assistance completing the paperwork, please contact us by telephone or contact page on this site. Thank you and we look forward to seeing you soon!