New Patient Registration - Registración de Nuevos Pacientes
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. A deposit payment of twenty-five dollars ($25). We accept cash, debit, and credit card.
• Your payment will be applied toward the total charges for the services rendered on your new appointment date. The actual charges will vary depending on the services you receive and the federal poverty guidelines.
• If you have medical insurance, you are required to provide your insurance card at the time of registration. The $25 deposit will not apply to you. You will be charged your assigned co-payment by your insurance when checking in for your visit.
• We currently accept Medicare, Medicaid, Coventry, Aetna, Humana, Medicare Advantage Plans, United Health Care, and Blue Cross Blue Shield.
3. 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 apply.
Proof of income required for new and current patients: (two needed)
1. Most recent federal income tax return (all forms and schedules filed, full packet).
2. 3 months of most recent pay stubs consecutive with no gap from all people employed in the household.
3. Separation notice or unemployment claim.
4. The three (3) most recent bank statements (all pages included) showing all of the following:
• Savings, checking accounts' balance and investment accounts.
• Department of Labor deposits.
• Government assistance program (rent assistance, if applicable)
• Award letter from Social Security (SSN)
• Profit and loss report for all employed applicants.
• Current CD, 401K, IRA, or other investment statements.
• Notarized self-attesting from patient or financial provider.