New Patient Eligibility Questionnaire Eligibility Do I qualify for free clinic visits? You must be an adult (>18 years old) and must live in the Charleston Tricounty area. You must be uninsured (no health insurance). Your household income must be 250% or less than the Federal Poverty Level (FPL). Here is a website for FPL calculator to help determine your eligibility. https://home.mycoverageplan.com/fpl.html Demographics * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country How did you hear about us? Friend Hospital/Clinic Internet Search Message * Response A volunteer from Harvest Free Medical Clinic will call you in response to your message. If we are unable to reach you after two attempts, please call (843) 747-3526 to leave a voicemail message on the new patient line. Thank you! A volunteer from Harvest Free Medical Clinic will call you twice in response to your message. If we are unable to reach you after two attempts, please call (843) 747-3526 and leave a voicemail message on the new patient line.