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Our Services

New Patient Registration

We are currently accepting new medical patients; however our new patient slots are limited and are assigned on a first come first serve basis.  Once you are a new medical patient, you may be referred, if needed to our dental department. Please call our office at 770-419-3120 Ext. 112 or 113 to inquire about the pre-registration process.

New Patient Requirements

1. Current valid government issued photo identification (i.e. driver's license or passport).

2. Proof of income of the household in which you reside. GSHC defines "household" as any group of people financially dependent upon one another. Please bring all that applies. We accept the following items as proof of income.

Option 1:
• Three months of the most recent paycheck stubs from all persons employed in the household.
• Most recent federal income tax return (all forms and schedules filed)

Option 2:
• Separation notice or unemployment claim
• The three (3) most recent bank statements showing all of the following:(1) Savings, checking accounts' balance, current CD, 401K, IRA, and other investments;(2) Department of Labor deposits;(3) Government Assistance Program (rent assistance)
• Award letter from SSN (social security)
• Profit and loss report for all employed applicants
• Notarized self-attesting from patient or financial provider

3. $25 deposit payment. We accept cash, debit, and credit card.
•Your payment will be applied toward the total charges for the services rendered on your first appointment. The actual total charges will vary depending on the services you receive and the federal poverty guidelines.

4. If you have insurance, your insurance card is required at the time of registration and at every appointment. You will be charged your applicable copay for your doctor's appointment.
• The $25 registration deposit payment does not apply if you have insurance
• We accept the following insurance plans: Medicare, Medicaid, Coventry, Aetna, Humana, Medicare Advantage Plans, and Blue Cross Blue Shield.


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© 2018 The Good Samaritan Health Center of Cobb

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