Eligible for Free Health Care? Barrier Islands Free Medical Clinic

Do you currently have health insurance? *

Yes (if you select 'yes,' you are ineligible for free care at this time)

No

If you answered NO, you may be eligible for free health care services and should proceed with this quiz. If you answered YES but have questions about financial eligibility, contact our office for further information.

Do you receive Medicaid, Medicare, or have VA benefits? Please check the box that best applies to you. *

Yes, I receive Medicaid.

Yes, I receive Medicare.

Yes, I receive VA benefits.

No, I do not have any form of health insurance.

If you answered NO, you may be eligible and should proceed with this quiz. If you answered YES but have questions about financial eligibility, contact our office for further information.

Do you currently reside in one of the following areas: Johns Island, James Island, Wadmalaw Island or Folly Beach, Meggett, Ravenel, Hollywood, or Walterboro? Please select the option thatbest applies to you.

Do you currently work (in any capacity) on Johns Island, James Island, Wadmalaw Island or Folly Beach? Please check the box that best applies to you.

Do you currently work in the Hospitality Industry (Restaurant, Bar, Hotel, Tourism) on the Charleston Peninsula or West Ashley?

Yes, I work at (please list place of work):Yes, I work at (please list place of work):

No, I do not

Do any of the below financial situations apply to you? If so, please place a check next to your annual income level and household size

I am single and I earn $43,594 or less a year.

I live in a 2 person household and earn $58,963 or less a year.

I live in a 3 person household and earn $74,331 or less a year.

I live in a 4 person household and earn $89,700 or less a year.

I live in a 5 person household and earn $105,069 or less a year.

I live in a 6 person household and earn $120,437 or less a year.

I live in a 7 person household and earn $135,806 or less a year.

Do you currently live with family members, dependents, or roommates? Check which box applies to your housing situation:

I currently live with family members and/or dependents

I currently live with roommates

I do not currently live with anyone

If you live with a non-familial roommate(s), do you rely on those in your household for financial support OTHER than housing costs?

Yes

No

N/A

To confirm your eligibility status, please provide your name and preferred contact information, and submit the form below. A representative will be in touch with you shortly.

Name *

Email Address (please provide if you would like us to contact you via email)

Phone Number (please provide if you would like us to contact you via telephone)

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