How to Become a Patient
Qualification Procedure
To become qualified as a patient you must make an appointment to determine eligibility. For your convenience you may download the registration forms below and fill them out in advance. In addition to the forms here, the following documents must be presented at the first appointment:
Current local photo identification
Social Security Card
Utility bill for proof of residence
Proof of all household income*
*Current tax return for the household (required if filed) OR Four current pay stubs for each employed person in the household OR A notarized letter of employment for each employed member of the household stating the average number of hours worked per week and the gross rate of pay.
Patients will be requalified in May of each year by providing a copy of their current income tax return or other current proof of income. These items may be faxed to New Patient Services, 251-460-0992.
Patient Fees
Patient fees are calculated on a sliding scale that is based on family size, gross family income and circumstances. Patients who have not yet qualified will pay $60 per office visit for up to two physician visits. Non qualified patients are also eligible for one lab visit ordered by VHP physicians. The cost of the lab visit depends on the type and number ordered.
Victory does not bill patients for services rendered. Patients are expected to pay for services at the time of the office visits with cash or local check.
Lab fees are a separate charge and are also due at the time of service. Through a donation from Quest Labs we are able to keep our lab fees low.
To be a patient of the clinic a $60 annual administrative fee is required. This fee helps us to defer the costs of providing the dispensary and the Patient Assistance Program. There is no charge for medications dispensed through the programs. No medication will be dispensed until the administration fee is paid. In addition there is no charge for urine tests, strep tests, x-rays, EKG’s, counseling and the Pulmonary Clinic. Thank you for helping Victory qualify you as a patient.