Financial Requirements

Please review below to determine which category describes your situation and the documents required

You filed federal taxes in the last tax year:

Your current tax return: You may provide the complete tax return, or the Form 1040 (2–3 pages) and Schedule 1, if Schedule 1 was included with your return.
Completed and signed MLH Financial Assistance Application (Schedule C): You must come to Phoenixville Free Clinic to complete and sign this.
A valid photo ID

You have never filed taxes OR did not file taxes in the last tax year:

Current W-2 from all the people working in your household
Last 12 bank statements from all bank accounts of all the adults in your household
Employer letters (notarized or with company logo) for all the people working in the household if they cannot provide a W-2.
Birth certificates and marriage licenses from all dependents if you have not provided them to the clinic in the past.
Employer letter (notarized or with company logo)
Notarized letter of the person who supports the patient when they don’t file taxes and don’t have insurance
A valid photo ID

It may take 2–3 weeks to receive a determination after we receive all required documents. Delays in submitting your documents may result in a delay in receiving medical care.

If you have questions or concerns, please contact us at (610) 935-1134, extension 162, or email finance@phoenixvillefreeclinic.org. You may also stop by our front desk Monday–Friday during our regular Clinic hours, and our staff will be happy to assist you.