SVdP Pharmacy Patients
Current patients: to renew your application, please click below.
New patients: scroll down to read qualifications for service and how to apply.
Patient Eligibility Requirements
Current patients: to re-submit your application, please click below.
New patients: scroll down to read qualifications for service and how to apply.
Qualifications for Service
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You must be a resident of the state of Texas,
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have an annual household income below 300% of the Federal Poverty level for your family’s size,
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have no health insurance, and
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have a valid prescription for your medication.
To Apply
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Fill out the application
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Type your answers into the fillable PDF, then save the document to your computer
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You may also download and print the application to complete by hand.
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Gather all your documentation:
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Proof of residence
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Proof of income
If you have no income, or someone helps to support you, you can submit the Hardship Referral Letter to meet the proof of income requirement. -
Photo ID
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Prescription
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Due to COVID-19, all applications and documentation must be scanned and emailed to [email protected]
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Applications submitted with documents missing are considered incomplete and will not be considered until all information is submitted
Services Provided
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No cost for your prescription medications
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Medication counseling
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Refill reminders
- Delivery assistance:
- Potential delivery of medications to clinics
- Mail order delivery
Qualifications for Service
- You must be a resident of the state of Texas,
- have an annual household income below 300% of the Federal Poverty level for your family’s size,
- have no health insurance, and
- have a valid prescription for your medication.
To Apply
- Fill out the application
- Type your answers into the fillable PDF, then save the document to your computer
- You may also download and print out the application to complete by hand.
- Gather all your documentation
- Proof of residence
- Proof of income
- photo ID
- Prescription
- Due to COVID-19, all applications and documentation must be scanned and emailed to [email protected]
- Applications without all required documentation are considered incomplete and cannot be approved until all required documents are received.
Scroll down to submit your application.
Services Provided
- No cost for your prescription medications
- Medication counseling
- Refill reminders
- Patient Assistance Program enrollment
- Delivery assistance:
- Potential delivery of medications to clinics
- Mail order delivery
Submit Your Application
If you are a new patient, click on the button below, and fill out the entire form. Once you have finished, save the file to your computer. Then, please email your application and documentation to: [email protected].
DON’T FORGET to also attach your documentation. Remember that if you have no income or someone supports you, to complete the Hardship Referral Letter. Applications without all required documentation are considered incomplete and cannot be approved until all required documents are received.
Have questions about your application? Not sure whether you qualify?
Call Us Today. We’re happy to help!
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