Care | Prevent | Educate | Engage

Steps To Becoming A Client

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There are three steps to becoming a client.  The Intake Coordinator is here to help you through this process:

 Step 1: Intake

  • Call 541-342-5088 or Toll Free 1-866-470-3419 and ask for an Intake Coordinator.
  • Schedule an appointment for enrollment via walk in or by phone.
  • Complete and return intake paperwork
  • Provide information about where we can obtain HIV verification for you
  • Provide the following:
    • Income Verification
      • Work income (2 months current, consecutive pay stubs or earnings statements for ALL jobs)
      • Self-employment income (most recent quarterly tax returns or business records for the most recent 3 consecutive months)
      • Unemployment benefits (compensation stubs)
      • Disability benefits (award letter)
      • Stocks, bonds, cash dividends, trust, investment income, royalties (documentation from financial institution showing income received, values, terms, and conditions)
      • Alimony/Child support, foster care payments (benefit award letter or official document showing amount received regularly)
      • Pension or retirement income (not SSI) (annual benefit statement)
      • Social Security retirement/survivor’s benefits (annual benefit statement)
      • Veterans benefits (benefit award letter)
      • Social Security Income (SSI/SSDI) (annual benefit statement)
      • Public Assistance (not SNAP or LIHEAP) (most recent payment statement or benefit notice)
      • Worker’s Compensation or sick benefits (benefit award letter)
    • Proof of Residency
      • One of the Following:
        • Unexpired Oregon Driver License
        • Unexpired Tribal ID
        • Unexpired Oregon State ID
        • Utility bill (cell phone bills not accepted)
        • Lease, rental, mortgage, or moorage agreement
        • Most recent property tax document
        • Residency Verification Form (will be provided only if no other form of documentation
      • OR Two of the Following:
        • Copy of SSI/SSDI Award
        • Copy of public assistance document (SNAP, OHP, etc.)
        • Current Oregon Voter Registration Card
        • Pay-stubs showing the employee’s home address
        • Documents issued by a financial institution (bank statement, credit card bill)
        • Court Corrections Proof of Identity
        • Homeowner’s Association fee
        • Military/Veteran’s Affairs
        • Oregon vehicle title or registration card
        • Approved letter from Oregon State Hospital, homeless shelter, transitional service provide

Step 2: Care Coordination Screening

  • This is a chance to meet with your Care Coordinator to talk about your needs and create a plan for your care.  The Intake Coordinator will schedule this with you.

Step 3: RN Health Assessment

  • The RN will talk with you about your health and answer questions.  Together you will identify ways to improve your wellness.  The Intake Coordinator will schedule this with you.

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Copyright 2015 HIV Alliance.

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