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Become a Patient

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No Income Form

Find us in Laurens County!

What to bring with you:

  • Proof of income for everyone in the home in which you live.

  • Proof of physical address such as drivers license, SC ID, or bill with name and address printed on it.

  • Examples of Qualified income:

    • Recent paystub
      most recent tax return (1040)

    • Benefit award letter for social security disability or benefit statement for SSA retirement.

    • Court documents for alimony/child support.

    • IRS 1040 w schedule C for self employment.

    • Unemployment statement.

    • Last statement of retirement/pension. account

Contact & Location

245 Human Services Rd,

Clinton, SC 29325

864-833-0017

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