Forms & Resources
- 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 – one of the following: Photo ID with current address, lease, mortgage, utility bill in patient’s name. If you are not a resident of John’s, James, or Wadmalaw Island, 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 experiencing a personal crisis or situational emergency, please find a list of Emergency Resources Here.
Are you a current patient? Please take a moment to answer a few survey questions so we can continue to best serve our community.