Now Accepting New Medical and Dental Patients

We are currently welcoming new medical and dental patients! However, appointment availability is limited and offered on a first-come, first-served basis.

To get started, please call us at (770) 419-3120 to inquire about new patient registration.

Before your first appointment with a provider, you must schedule a New Patient Registration Appointment.

Please note: This is not a medical or dental appointment — you will not see a doctor or dentist on this day. This visit is only for completing the registration process.

After completing your registration appointment, you'll be eligible to schedule your first medical or dental visit and may be referred for additional services, if needed.

IMPORTANT NOTICE

To complete your registration, you MUST bring physical (paper) copies of your proof of income to your scheduled registration appointment.

• Electronic versions (on phones, emails, or other devices) will NOT be accepted.
• We are unable to print documents for you at the clinic.

If you do not bring printed proof of income, your registration will be rescheduled for the next available date next month.

Keep reading below to learn what documents and requirements you’ll need for registration.

New Patient Requirements

To schedule your first appointment, please prepare the following:

1.    Valid Photo ID

Bring a current, government-issued photo ID (e.g., driver’s license or passport)

2.    Deposit Payment

A $45 deposit is required at the time of registration. We accept cash and debit/credit cards, check.

• This deposit will be applied toward your total charges on your first visit.
• Final charges will vary based on the services received and federal poverty guidelines.

Have Medical Insurance?

If you provide a valid insurance card at registration, the $45 deposit is waived. Instead, you’ll be charged the co-payment amount required by your insurance.

Please note: We only accept medical insurance. Dental services are not covered by insurance at our center and must be paid out of pocket.

Accepted Medical Insurance Plans:

• Medicare
• Medicaid
• Oscar
• Ambetter
• Aetna
• Humana
• Medicare Advantage Plans
• United Health Care
• Blue Cross Shield

3.    Proof of Household Income

Good Samaritan Health Center of Cobb defines a household as anyone who is financially dependent on or supporting one another.

Please note: We are not a free clinic — fees are based on a sliding scale depending on your income and household size.

You must provide two forms of income verification. See options below:

Option 1 - Getting Paid by Check

• Most recent federal income tax return (full packet, including all forms and schedules)
• Three months of most recent pay stubs (consecutive, no gaps) for all working members of the household

For example:
• If paid weekly, provide your last 12 pay stubs
• If paid bi-weekly, provide your last 6 pay stubs

Option 2 - Getting Paid in Cash

• Notarized letter from employer(s) or letterhead from the employer providing an estimate of your salary and how often
• Three most recent bank statements (including all pages) showing any of the following:
  • Checking/savings/investment account balances
  • Department of Labor deposits

Option 3 - Homeless

• You must provide a shelter letter. A shelter letter is required at each appointment and must be dated the same date as the appointment

Option 4 - Other

• Three most recent bank statements (including all pages) showing any of the following:
  • Checking/savings/investment account balances
  • Department of Labor deposits
• Most recent federal income tax return (full packet, including all forms and schedules)

• Any financial assistance

  For example: Food stamps, SSI, Disability.

Option 4- Dependents

• Provide a notarized letter from the financial provider (Good Samaritan defines a financial provider as someone who offers you shelter, food, transportation, insurance, and/or monetary value of the assistance provided) 
  
  Please note: This letter is only required if the dependent is not listed on the tax form.