Patients of the Fauquier Free Clinic must meet our basic eligibility requirements to receive free care. To be eligible, you must live in Fauquier or Rappahannock County, you cannot have health insurance, and your household income must be under our limits. We need to have written documentation that you meet these guidelines to help you, and to get your medications. Information can be brought to the clinic or mailed to:
Fauquier Free Clinic, Inc.
P.O. Box 3138
Warrenton, VA 20188
If you are married and living together, we need documents for patient and spouse. For children, documents of the parents living with the child are required.
Patients of the Fauquier Free Clinic must live in Fauquier or Rappahannock County. You must provide proof, such as a driver’s license, current utility bill, voter registration card or a rental lease. You must have this at your first visit or you will not be seen.
Must provide proof of income every 6 months. See below for what is required:
You have 2 weeks to provide documentation once notified what is needed.
One month of current pay stubs.
Copy of Income Tax by April 15
Last pay stub for previous year, showing year to date income
Verification of Employment Letter (we will provide and you will have employer fill out).
Wage and Earning Statement from the Virginia Employment Commission: we will have you fill out a form which we will fax to their office.
Verification of Employment Letter (we will provide and you will have employer fill out). We will need a copy of your pay stubs when you get them.
Your mo st recent tax return if you filed in the past year. Letter of Support from individual who is helping with expenses (clinic will provide you a letter to be completed by person helping with your support).
We need a statement showing how much you receive. For example if you are receiving Social Security benefits, Veterans Benefits, pensions, food stamps, Unemployment Compensation or child support we need a statement from the provider.
If you do not provide the information requested by the specified dates you cannot be seen or given referrals or medication refills until you provide it.
Copyright © 2013 - Fauquier Free Clinic - All rights reserved.