Care For Life
 
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HOURS OF OPERATION

The clinic is open for Financial Screenings on the 1st and 3rd Tuesday of every month between 9am-12noon.  Appointments are necessary.  Please call for an appointment as well as a list of items to bring to your appointment so that you may prove your HOUSEHOLD INCOME, such as:

Patient  Information  (or Patient’s Father-if child):      
If you are employed, bring:           

  • Last 3 Paycheck Stubs
  • Last 3 months of Bank Statements
  • W-2 VERIFICATION/1099
  • Copy of Tax Return

If you are not employed, bring:

  • Proof of Social Security or Disability Benefits
  • Proof of Government Assistance
  • Unemployment Letter
  • Application Inquiry Form (Dept. of Labor)
  • Separation Notice  

Spouse's Information  (or  Patient’s Mother- if child) :
If you are employed, bring:           

  • Last 3 Paycheck Stubs
  • Last 3 months of Bank Statements
  • W-2 VERIFICATION/1099
  • Copy of Tax Return                    

If you are not employed, bring:

  • Proof of Social Security or Disability Benefits
  • Proof of Government Assistance
  • Unemployment Letter
  • Separation Notice      

*Patients with no income, require an official document such as: a Non-Filers statement from the IRS, income Tax return, a statement from the unemployment office, a termination letter from a recent employer, or verification of benefits from the DFACS office.

Must have: Picture ID _____    Utility Bill_________                 

OTHER WAGES or applicable documentation: (child support income, alimony, stimulus funds, food stamps, rental income, royalties, interest dividends, insurance payments, self-employment, workers compensation, retirement benefits, pensions, unemployment ,training stipends, scholarships, military allotments, AFDC, TANF, SSI, etc.)

Anyone providing false information will be terminated from the program.
Patients not providing necessary documentation will not be eligible for services.
Our policy requires that income information must be updated and verified at least once a year.

Patients requiring dental procedures will be scheduled an appointment as the volunteer dentist and staff becomes available. Usually patients will be seen on days in which dentists will volunteer their time, more commonly, on Mondays or Fridays.


To schedule an appointment call:
478-953-7770
Staff Hours:  Monday-Friday 9am -4pm

 

 


 

 
 

 

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