New Patient Information
HOW TO BECOME A MEDICAL PATIENT
FastTrack Medical | Priority ZIP Codes 30318 and 30314
- We are always accepting prenatal and pediatric patients. Please call 404-523-6571 for more information.
- Requires proof of income, address, ID, and insurance card (if applicable). You must have these documents to be seen.
Non-FastTrack | Outside of priority ZIP Codes.
Registration is online only. The procedure is first come first serve. Web registration opens at 8:00 am and will close when all the slots are full.
Medical New Patient intake dates for 2023:
HOW TO BECOME A DENTAL PATIENT
FastTrack Dental | Priority ZIP Codes 30318 and 30314 may *register at any time by calling: 404-523-6571 and dial ext. 4974
Requires proof of income, proof of residency, and ID. You must have these documents to be seen.
Non-FastTrack | Outside of priority ZIP Codes must be established and active medical patients of Good Sam. This will be verified with your medical provider.
Registration is online only. The process is first come first serve. Web registration opens at 8:00 am and will close when all the slots are full.
Dental New Patient intake dates for 2023:
Requires proof of income and ID. You must have these documents to be seen.
*Deposit of $75 is made at the time of New patient registration/scheduling initial appointment (Deposit will go towards New patient exam and x-rays).
Dental Walk-in Appointments/Emergencies with Valid Photo ID.
- Dental walk-in for emergency extractions only.
- First-come-first-served basis. Monday through Thursday is conditioned upon the healthcare provider's schedule. We cannot guarantee that we will see all walk-in patients.
- All walk-in patients must check in by 7:45 am and wait for an available appointment.
- A non-refundable $20 initial assessment fee will be charged and includes oral evaluation and x-ray (an additional fee may apply considering the services rendered).
- The cost of extraction is $60.00
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.
- 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 a 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.
All medical fees vary based on income. A medical office visit can range between $40-120 per visit as determined by Federal Poverty Guidelines for FastTrack patients (ZIP codes of 30318/30314) and $60-140 for patients outside the priority ZIP codes of 30318/30314.
All dental fees vary based on procedures. We do not accept insurance for dental procedures. We are a fee-for-service clinic.
Individual and family counseling is offered at an affordable price. Please call 404-523-6571 for more information.
PLEASE NOTE: Immunization Records, Medical Records, Referral Vouchers and other administrative services are a separate cost.
Patients with income 200% and above the federal poverty level are responsible for the full cost of services.
|Household Size||Low-Inc Tier||Mid-Inc Tier||High-Inc Tier||100% (HSA)|
|1||$0 - $17,774.40||$17,774.41 - $19,320.00||$19,320.01 - $25,760.00||≥$25,760.01|
|2||$0 - $24,039.60||$24,039.61 - $26,130.00||$26,130.01 - $34,840.00||≥$34,840.01|
|3||$0 - $30,304.80||$30,304.81 - $32,940.00||$32,940.01 - $43,920.00||≥$43,920.01|
|4||$0 - $36,570.00||$$36,570.01 - $39,750.00||$$39,750.01 - 53,000.00||≥$53,000.01|
|5||$0 - $42,835.20||$42,835.21 - $46,560.00||$46,560.01 - $62,080.00||≥$62,080.01|
|6||$0 - $49,100.40||$49,100.41 - $53,370.00||$53,370.01 - $71,160.00||≥$71,160.01|
|7||$0 - $55,365.60||$55,365.61 - $60,180.00||$60,180.01 - $80,240.00||≥$80,240.01|
|8||$0 - $61,630.80||$$61,630.81 - $66,990.00||$66,990.01 - $89,320.00||≥$89,320.01|
|Each additional person||$0 - $6,265.20||$6,265.21 - $6,810.00||$6,810.01 - $9,080.00||≥$9,080.01|