Become a Patient

Become a Patient

STEPS TO BECOMING A MEDICAL PATIENT

We are always accepting prenatal and pediatric patients. Please call 404-523-6571 for more information.

If you are interested in becoming an adult medical patient, please call 678-515-0241 to schedule your orientation appointment. When you hear the message, please leave your first and last name, county of residence and all phones numbers where you can be reached. Only one attempt will be made to reach new patients. If message box is full, please try calling back on the first day of the next month. Registration is limited and occurs on a monthly basis.

 

Documents to Bring

We are not a free clinic. For patients without insurance, services are offered on a sliding fee scale. Patients are eligible to receive care determined by income and household size, based on 200% and below Federal Poverty Guidelines. Students and residents of rehabilitation centers, shelters, or transitional housing are eligible to become a patient. We accept Medicaid, Medicare, and select insurance for primary care only.  

  • Proof of Identification (Drivers Licenses, ID Card, Passport)
  • Proof of Income (W2 Statement, Last Three Paycheck stubs, unemployment letter from Department of Labor, Notarized Letter from Employer or current Tax Return)*Proof of income MUST be updated every year. All proof of income expires May 31st*
  • Patients residing in shelter or rehabilitation center must provide a letter confirming their residency and employment status to receive free service.

Our Fees Explained

Good Sam believes in making high quality dental and medical care available for every family regardless of their financial situation. We expect our patients to pay according to their ability.

Dental

All dental fees vary based on procedures. We do not accept insurance for dental procedures.

Medical

All medical fees vary based on income. Medical office visit can range between $40-120 per visit determined by Federal Poverty Guidelines. Patients with income 200% and above federal poverty level are responsible for the full cost of services.

Household Size 100% 138% 150% 200%
1 $11,770 $16,242 $17,655 $23,540
2 $15,930 $21,983 $23,895 $31,860
3 $20,090 $27,724 $30,135 $40,180
4 $24,250 $33,465 $36,375 $48,500
5 $28,410 $39,205 $42,615 $56,820
6 $32,570 $44,946 $48,855 $65,140
7 $36,730 $50,687 $55,095 $73,460
8 $40,890 $56,428 $61,335 $81,780

Immunization Records, Medical Records, Referral Vouchers and other administrative services are a separate cost.

Counseling

Individual and family counseling is offered for an affordable price.  Please call 404-523-6571 for more information.