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:
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:
Envelope with your Mailing Address
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)
Rental or Heating Assistance
Please submit a copy of your most recent tax return if one has been filed.