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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

Drivers License.png

Non Driver ID Card

Non Driver ID Card.jfif
passport.png

County Card ID

County Card ID.png

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

Utility Bill.png
Envelope.PNG

Envelope with your Mailing Address

Landlord Letter

Landlord Letter.png
Rent Receipt.png
Rent Receipt 2.png

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:

  • Self-Employed (includes owned business, day labor, any cash income)

  • Pension / Retirement Income

  • Social Security Benefits (including SSI)

  • Disability Benefits

  • Veterans Benefits

  • Workers Compensation

  • Unemployment Compensation

  • Rental Income

  • Food Stamps

  • Rental or Heating Assistance

  • Alimony

  • Child Support 

Example Images:

Pay Stub

Pay Stub.png

Employment Verification

Employment Verification.png

Tax Return:

Please submit a copy of your most recent tax return if one has been filed.

Tax Return.png

Vaccination Card (if vaccinated):

Vaccination Card.png
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