Eligibility Requirements

Surry Medical Ministries Clinic focuses on equal access to healthcare for all persons. Our clinic provides primary care services to everyone without regard to race, color, religion, gender, gender expression, national origin, disability, marital status, sexual orientation, military status, or the ability to pay

Eligible Patients:

  • Are uninsured (no Medicaid, Medicare or health insurance of any type) have a household income of no more than 200% FPL link to FPL guidelines chart are aged 18+
  • Live in our Greater Surry County service area zip codes within 25 miles of the hospital. Primary Service area zip codes include the following:
    NC – 27030, 27007, 27017, 27024, 27041, 28621, 27047, 28676, 27053, 28627, 28668, 28683, 27043, 27021, 27019, 27022, 27016, 27018, 27011, 28642
    VA - 24317, 24053, 24171, 24333

Click to Enlarge

Surry Medical Ministries
Surry Medical Ministries

How to Access Services

  • All medical/dental services are provided by appointment only, (336) 789-5058.
  • Any patient who wishes to receive services at Surry Medical Ministries Clinic must have a current eligibility certification (enrollment) to be seen by a medical provider or to fill medication prescriptions.
  • Eligibility certifications/enrollments may be completed at the same time as scheduled appointments or patients may come to the Clinic prior to scheduled appointment to complete certification separately.
  • Please bring all requested documentation for certification/enrollment

What To Bring To Your First Clinic Visit

Bring all requested information to first visit to determine eligibility. If you have questions or difficulties with any of the required documents, please contact our staff prior to first appointment, (336) 789-5058.
Patients renew eligibility annually unless other agreements are made with eligibility office.

Patients with IncomePatients with NO Income
Photo ID (drivers license or government issued ID)Photo ID (drivers license or government issued ID)
Most Recent Two Months Pay Stubs/Or Proof Of IncomeLetter of Support: Download required form or will receive at first visit print one letter for each person or organization who provides support
Most Recent Bank StatementMost Recent Bank Statement
Two proofs of address (utility bills, credit card bills, vehicle registration, etc)Two proofs of address (utility bills, credit card bills, vehicle registration, etc)
Social security numberSocial security number
Proof of any additional household support such as:
Most recent award (income) letter from Social Security
-
Child support letter-
Workman’s comp or unemployment benefits-
Any other sources of income or household support not mentioned here-
If you are paid in cash, print the attached form (ability to download a form) or receive it on the first visit.-
OR Provide your tax return from the previous year-
Patients with IncomePatients with NO Income
Photo ID (drivers license or government issued ID)Photo ID (drivers license or government issued ID)
Most Recent Two Months Pay Stubs/Or Proof Of IncomeLetter of Support: Download required form or will receive at first visit print one letter for each person or organization who provides support
Most Recent Bank StatementMost Recent Bank Statement
Two proofs of address (utility bills, credit card bills, vehicle registration, etc)Two proofs of address (utility bills, credit card bills, vehicle registration, etc)
Social security numberSocial security number
Proof of any additional household support such as:
Most recent award (income) letter from Social Security
Most recent award letter for Food Stamps monthly allotment (Dept of Social Services can provide this)
Child support letter-
Workman’s comp or unemployment benefits-
Most recent award letter for food stamps monthly
allotment (Dept of Social Services can provide this)
-
Any other sources of income or household support not mentioned here-
If you are paid in cash, print the attached form (ability to download a form) or receive it on the first visit.-
OR Provide your tax return from the previous year-