|
If
you are between the ages of 50 and 64 and have NO medical insurance you
may be qualified for a |
| Are
you a female between the ages of 50 or 64 (with proof of age)? (Drivers license, State ID, or any reasonable proof of age) |
[ ] YES |
| Are
you uninsured or underinsured/limited benefits? (Insurance does not cover wellness visits) |
[ ] YES |
| You
have not had a mammogram in the last 10 months or You have not had a pap test in the last 10 months |
[ ] YES |
| My income is within the following guidelines. | [ ] YES |
|
Family size |
Monthly income |
Yearly income |
|
1 |
$1,595 |
$19,140 |
|
2 |
$2,138 |
$25,660 |
|
3 |
$2,682 |
$32,180 |
|
4 |
$3,225 |
$38,700 |
|
5 |
$3,768 |
$45,220 |
|
6 |
$4,312 |
$51,740 |
|
7 |
$4,855 |
$58,260 |
Volunteers
in Medicine
41 East Duval Street
Phone: (904) 399-2766
Fax: (904) 549-8300
Website: www.vim-jax.org
I.
M. Sulzbacher Health Center for the Homeless
Phone: (904) 359-0457, ext. 263
Fax: (904) 353-7345
Phone: (904) 630-3372
Fax: (904) 665-3107
Phone: (904) 301-4900
Fax: (904) 924-1770
Planned
Parenthood Central
Phone: (904) 399-2800
Fax: (904) 399-2333