Insurance: The patient may NOT have health insurance.
Residency: You must live or work in Beaufort County.

Income Verification:
• If you, as the patient, have a job, you must provide a copy of the two most recent pay stubs (within 45 days of new patient appointment).

• If you, as the patient, are living with someone who supports you, they must complete an In Exchange Form prior to coming in for an appointment. The form must be signed by the person providing support.

• If you, as the patient, support yourself with odd jobs, you must have a Self-Declaration of Income Form signed by one of their employers prior to coming in for an intake appointment.

• If you, as the patient, are homeless, you will need to complete a No Income Form and have an outside person sign the form prior to coming in for an intake appointment.

• If you, as the patient, are self-employed, please bring the first 2 pages and Schedule C from the prior year’s tax return or 1099.

• As the patient, the address on your photo id must match the address on your application. If it does not match, please bring a bill with their name and home address which will be shown on the application.

• If you do not have a social security number, you must go to the SC Department of Health and Human Services, 1905 Duke Street to obtain a current form 3300. This is important as Welvista will require this document for anyone without a valid Social Security number.

Income Eligibility