• Eligibility Requirements
  • Services NOT Offered
  • Patient Information
  • Income Verification
  • History and Physical
  • Medical History
  • Family History
  • No Show Policy
  • Consent to Treat
  • Eligibility Requirements
  • Services NOT Offered
  • Patient Information
  • Income Verification
  • History and Physical
  • Medical History
  • Family History
  • No Show Policy
  • Consent to Treat

Jean B. Purvis Community Health Center

Application for services

The Community Health Center (CHC) IS NOT INSURANCE. All services provided by CHC are FREE. CHC is Volunteer-Powered and Community-Funded. CHC does not provide emergency care.


APPLICATIONS, PROOF OF INCOME, AND LAST YEAR'S TAX RETURN (OR VERIFICATION OF NON-FILING) ARE REQUIRED TO DETERMINE ELIGIBILITY FOR SERVICES.


SERVICES WILL NOT BE SCHEDULED WITHOUT THESE DOCUMENTS


Eligibility Requirements:

- Age 19-64

- Uninsured or Underinsured

- Have a countable household income below 300% of the Federal Poverty Income Guidelines (listed below)

**Household is defined as applicant, spouse, and dependents

- Not currently seeing physicians for the services requested

**Ex. Having a PCP but requesting medical services

(We do not duplicate services)


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