Eligibility Requirements

Medical Patient Eligibility

Medical patients must bring the following:

1. A copy of your current insurance card


2. If you have no insurance then the following documentation is needed prior to being seen:

Residency – This is two pieces of recent mail (2 months) that have your resident address, not a PO Box; or a copy of your lease or mortgage.

Income – Documentation for the marital household, husband, wife, and working children.


1 month of recent pay stubs

Court Order regarding child support

Recent benefit letters regarding pensions, social security, or unemployment

Self-employment documentation, Schedule C of your IRS1040, and self-employment record of income and expenses

SNAP benefits

Letter of support

1040 Federal Income Tax Return

Medicaid denial letter

If the requested documents are not provided at time of appointment you might not be seen.


Patient Registration form


Dental Patient Eligibility

Dental patients have two options for meeting eligibility requirements.

  1. Shenandoah County resident
  2. No dental insurance


  1. Present Medicaid card. This proves your income status and helps us know for which services you are eligible.