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How to become a patient at TOMAGWA

Initial requirements for becoming a patient at TOMAGWA are that you must:

            1) Live in our service area, 

            2) Have an household income of 200% or less of poverty level, and             3) Complete forms below and provide requested information. 

Individuals interested in becoming a patient at TOMAGWA must bring the below completed documents to a free screening on any Tuesday starting at 7:30 am. Patients are screened on a first come first serve basis.

New patient forms:

What you need to bring - English | Lo que necesita traer- Español

Eligibility Application - English |Solicitud de Elegibilidad-Español

HIPPA Disclosure - English | Divulgacion de HIPPA -Español

Statement of Support - English | Declaracion de Apoyo - Español

Wage Verification - English | Verificacion de Salario  - Español