Forms & Resources

(English/ Espanol)
Before you schedule an appointment at The Free Clinic, you will need to Download and Complete Our Patient Application and bring this with you, or you may fill it out at the Clinic before we can schedule an appointment. Forms include:

  • New Patient Instructions
  • Medical History Form
  • Consent for Treatment
  • Patient Application

Download and Complete Our Patient Application

Documents You Will Need to Provide Us

To establish yourself as a patient at The Free Clinic, you will need to provide the clinic with the following information:

  • Personal Identification – one of the following: driver’s license, ID, passport or birth certificate.
  • Proof of Residency or Employment on Johns, James & Wadmalaw Islands or Folly Beach; Meggett; Ravenel; Hollywood; Walterboro, OR proof of employment in the Hospitality Industry – one of the following may work: Photo ID with current address, lease, mortgage, utility bill in patient’s name, paystub with your employers address listed, or a letter from your employer.
  • No medical insurance or eligibility for Medicare, Medicaid, or VA benefits. This can also be found on your most recent Tax Return Documents.

If You Are Not Eligible

Are You Eligible? Take Our Easy Quiz.

If we determine you are not eligible for our free clinic services, we can direct you to the many other free patient care clinics throughout the Charleston area. If you are out of county/state, please refer to the National Association of Free and Charitable Clinics to find a clinic near you.

Emergency Resources

If you are experiencing a personal crisis or situational emergency, please find a list of Emergency Resources Here.