Forms & Resources
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
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 Island or Folly Beach – one of the following may work: Photo ID with current address, lease, mortgage, utility bill in patient’s name. If you are not a resident of John’s, James, & Wadmalaw Island or Folly Beach, but currently work there, please provide a pay stub with your employer 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
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.
If you are experiencing a personal crisis or situational emergency, please find a list of Emergency Resources Here.