HOW TO BECOME A PATIENT

1. Make Your Appointment for Eligibility Screening

Call (201) 342-2478 to schedule an appointment for eligibility screening.

2. Gather Your Required Paperwork

See the paperwork you should bring to your first appointment: Identification, Proof of Residency, and Proof of Income. Please scroll below for details

Proof of Identity

Please provide ONE of the following forms of proof of residency:

Passport

Driver License

Non Driver ID Card

County Card ID

Proof of Residency

You must provide proof that you live in Bergen County. Please provide ONE of the following forms of proof of residency: current utility bill or other bill, current rent receipt, current bank statement or another written proof of residents.

See examples below:

Utility Bill

Envelope with your Mailing Address

Landlord Letter

Rent Receipt

Proof of Income

You must provide proof of household income. Please provide ONE of the following forms of proof of income: recent employer pay stubs covering 8-weeks, or a letter from employer stating salary. (See example images below).

You must also provide proof of other sources of income from ALL HOUSEHOLD members such as: