New Patient Qualifications
To qualify as a patient, you must bring the following information to a Financial Screening at one of the posted times listed:
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Picture ID
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Social Security Card
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Proof of income for everyone in the household, totaling one month. (This includes unemployment, disability, social security, etc. Bring the award letter or if direct deposit, bring a copy of the bank statement showing the deposit.)
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Proof of Food Stamps (bring the award letter)
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Proof of Residency (a utility bill or bring a letter from the responsible person if the utilities are in someone else’s name.)
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Medicaid Denial Letter (You must go to the Department of Family and Children Services in your county and apply for Medicaid. Even if you do not qualify, we must have a Medicaid Denial Letter, which will be mailed to you after applying.)
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Last Year’s Tax Return (if you filed)
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List of ALL Medication(s) and Dosages(s)
Financial Screenings
Financial Screenings:
Tuesdays, 2:00 PM – 4:00 PM
or By Scheduled Appointment
Temple Clinic:
253 East Highway 78
Temple, GA 30179
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770-562-4501
info.raphaclinic@gmail.com
New Patient Applications
Please return your completed application to Tracey Hampton at tracey.raphaclinic@gmail.com or bring the completed application by the clinic. You may also mail it back to us.
You can download the application here.