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

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Non Driver ID Card

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passport.png

County Card ID

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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

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Envelope with your Mailing Address

Landlord Letter

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Rent Receipt.png
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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

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Employment Verification

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Tax Return:

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

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Vaccination Card:

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