First-time patients should print, complete and bring in a registration form. Please choose one:
Mercy Care is a federally qualified health center that provides care regardless of your ability to pay for it. For those who are uninsured or anyone who wants to apply for discounted fees/copays based on a sliding fee scale, we are required collect information from you during the registration process. The information collected determines what, if any, cost you will be responsible for at the time of your appointment. We will need to review these documents again annually or any time the information changes. If you register by phone, we will collect your registration information so you only need to show documentation when you arrive at one of our health centers. Please bring the following:
1. Photo ID (if applicable).
2. Proof of current address in the form of a utility bill lease agreement or homeless shelter letter. If your ID has your current address on it, additional proof of address is not needed.
3. Insurance card – please bring one of the following if applicable. We accept all major insurance plans.
- Commercial Insurance: your most recent insurance card.
- Medicaid: your most recent Medicaid card (Peach State, PeachCare for Kids, Wellcare, GHP or Amerigroup).
- Medicare: your red, white and blue card or the card provided by your Medicare HMO
4. Proof of income - Bring one of the following as proof of household income only if you want to apply for discounted fees/copays based on a sliding fee scale.
- A minimum of two (2) paycheck stubs, no older than 30 days.
- If you currently are not receiving income, you must present a Wage Inquiry form from the Georgia Department of Labor, no more than 30 days old.
- If you are self-employed, you may choose to show a recent tax return.
- If you are paid in cash, you will need to provide a letter from your employer stating your rate of hourly pay, amount paid each pay period, and how often you receive payment.
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