Existing Patients

Volunteers in Medicine | Patient ReQualifying Guidelines

We require all patients to financially requalify with us once a year. Only complete this form if you are a current VIM patient, and have been seen at our clinic in the last 18 months. If you have been a VIM patient in the past but have not been seen in over 18 months or if you are new to VIM, you will need to complete the New Patient Qualification Application.

Please use our financial guidelines below to help determine if you will continue to qualify for our services.

Reminder: If you are new to VIM, use this form to apply to become a patient