Patient Information

Patient Eligibility

  1. 18 years to 65th birthday
  2. A resident of Horry County
  3. 200% or below Federal Poverty Guidelines
  4. No access to medical insurance, Medicaid or Medicare

Application Process

Applications to become a patient at Friendship Medical Clinic may be mailed, e-mailed or downloaded from this website. Applications may also be picked up in person at 1396 HWY 544 Conway, SC (Monday – Thursday 830am- 4pm)

Patient Application Form

Download Here \

PLEASE READ INSTRUCTIONS CAREFULLY WHEN COMPLETING THE APPLICATION

Documents Required for Application

  1. Photo ID (South Carolina driver’s license or South Carolina photo ID)
  2. Verification of Income:

    • Tax return for the previous tax year
    • Last two pay stubs may be used if no tax returns are available.

Please call the clinic Patient line 843-347-7178 Monday-Thursday 9 a.m. - 1 p.m. with any questions regarding the application or application process. We want to help you receive medical care and medications.

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