Eligibility for Free Services //
Do you have any of these insurances?
United Healthcare Community
Medicaid-Department of Family Services
If the answer is yes, please fill out and submit the form below, stating which insurance you have and that you are questioning your eligibility. We will contact you shortly.
If the answer is no/I don't know, and you are comfortable filling out the form with your social security number and birthday, please submit it in the form below and we will contact you shortly. If you are hesitant, please call our intake coordinator at: