Becoming a New Medical Patient - 2026
Registration opens in the first week of every month.
Please note: After your submission, our team will contact you within 48 to 72 hours. Registration spots are limited and filled on a first-come, first-served basis.
Register Here: Slots for January have been filled. Please check back in the first week of February!
Becoming a New Dental Patient - 2026
Due to provider shortages we are currently unable to accept new dental patients.
*FUTURE DATES TO BE DETERMINED
We only offer emergency dental extractions, subject to schedule availability. Please call to inquire about this service.
$75 - Emergency Dental Extraction: X-Ray and oral evaluation ($30 non-refundable).
*$25 fee per additional tooth extracted.
IMPORTANT NOTICE
To complete your registration, you MUST bring physical (paper) copies of your proof of income to your scheduled appointment.
- Electronic versions (on phones, emails, or other devices) will NOT be accepted.
- We are unable to print documents for you at the clinic.
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 $60 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 $60 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/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.
