Pre-Qualification Screening

Prospective patients must call to review qualifications and set-up pre-qualification screening.  For more information please call 804-210-1368, Ext. 4.

Pre-Qualification days and times:

Tuesday and Thursday 10-11:45 a.m.



To be a patient at the Gloucester-Mathews Care Clinic you must be:

 A resident of the Middle Peninsula

 18 years of age or older

 At or below 250% of the Federal Poverty Level

 Patient must not have any insurance to include Medicare, Private or Veteran’s


Affordable Care Act

If you project your ANNUAL household income will be above 138% of the federal poverty level, you are required by federal law to have health insurance.  You must obtain what is called "minimum essential coverage." If not, you will be charged a fee for every month that you lack this essential coverage.  Your being a patient of the Gloucester Mathews Care Clinic DOES NOT qualify you as having health insurance.

Please call at 1-800-318-2596 for assistance.

What to bring to Screening Appointment?


At your screening you must provide income              

documentation for everyone listed on your tax returns:

1. Last two months worth of pay stubs.

2. Most recent 1040 tax return and:

               ~  A copy of any W-2s, or 1099s

         ~  If you are self employed your schedule C

         ~  If you did not file, you need to fill out a form 4506 T at your screening.

3. Proof of all other forms of income:

~  Unemployment Checks/Letter of Determination

~  Child Support/Alimony Checks or Court Decree

~  Social Security/Disability/Widow/ Widowers Benefits Letter

~  If unemployed, and not receiving unemployment benefits, you will need a  friend or family member to complete the GMCC Letter of Support Form, stating you are unemployed with no income and  how expenses are being met; GMCC Letter of Support Form is available at the Clinic or the Administration Office.

~  Food Stamps Benefits Letter

~  TANF Determination Letter

4. Copy of driver’s license or state ID, proving you are a Gloucester or Mathews resident.


There is a $10, $12, or $15 screening fee every six months depending on the patients income level to help support the Clinic.

     We will make your RE-SCREENING appointment at the time of your first screening.  YOU must reapply every six months to continue to be a patient.  The same financial information is required at your RE-SCREENING appointment.  A $5 fee will be charged for lost cards.

Remaining a Patient

Your Responsibilities

-Keep us informed of a working phone number.

-Show up for scheduled appointments, there are always people waiting to be seen. 

-Be courteous to the staff; many are volunteers

Emergency Room Use

-ER visits must be approved by the clinic or Riverside Nurse.  You will be responsible for the bill if you fail to get approval.

-After all ER visits YOU must call the clinic for a follow-up appointment.  This is YOUR responsibility.

-Excessive use of the ER may lead to being dismissed from the clinic.


  -Medication fee of $3, $4, or $5 per prescription depending on patients income level.

     - Diabetic testing strips are $7 per month.


 We will make your re-screening appointment at the time of your first screening. 

YOU must reapply every five to six months to continue to be a patient.  The same financial information is required at your re-screening appointment. The financial part of the process is the same as the initial screening.  The same information is required.  The same $10 fee applies. Consider keeping your pay stubs and tax documents in the blue folder we give you at your initial screening.  If your financial situation changes you are expected to let us know. If you get Medicare or Medicaid you are expected to let us know. We reserve the right to terminate your enrollment at any time.