Patient Information

At YourTown Health, everyone matters. Our primary goal is to increase access to high-quality, affordable healthcare services for our patients regardless of health insurance or financial status.

We do this with our Sliding Fee Scale, which calculates the amount patients pay for our services based on their household income and family size.

If you and your family have no insurance, you may qualify for our Sliding Scale Nominal and pay just $35 for each primary care medical and behavioral health visit. The Sliding Fee Nominal charge for dental services is $45.

As a Federally Qualified Community Health Center, we are required to obtain all of the following information for our records.

If the required eligibility information is not available at time of visit, patient will be triaged by a clinician to determine medical condition. If clinician determines patient must be seen, patient will be seen and payment arrangements will be made. If clinician determines that patient does not need to be seen on that day, an appointment will be offered within the next 48 hours. A Sliding Fee Application will be provided, allowing the patient to self-disclose income information for the rescheduled appointment. The patient will also be informed of the required documentation to bring to the next visit to establish eligibility.

New Patient Registration Forms

If you are a new patient, download and fill out the New Patient Registration Form (Spanish version of the New Patient Form). If possible, please bring your completed forms with you to your first appointment.

Documents to Bring to Your Visit

Patients with Insurance, Medicare or Medicaid

Please bring the following documents to each visit:

• Current Photo ID
• Insurance Card

Sliding Fee Scale Eligible

To find out if you qualify for our Sliding Fee Scale, please bring the following documents to your first appointment. If you’re an existing patient, bring the following documents annually (from the date of first application):

• Sliding Fee Scale application (Spanish version of the Sliding Fee Scale application)
• Proof of Address (utility bill, phone bill, or other official correspondence)
• Proof of Identification:
  • Current Photo ID (If you do not have a Photo ID, see our front desk for assistance)
• Proof of Income (only one of the following is required):
  • Minimum of two current paycheck stubs and proof of income for all in your household (or notarized letter from your employer) or
  • Income Tax Return or W2 Form (most recent) or
  • Disability/Worker’s Compensation Notification Form or Social Security Notification Form or Pension/ Retirement Statement or Veteran’s Benefits Statement or Child Support Court Award (must include amount of benefits) or
  • Current Food Stamp Summary or
  • Other documents showing proof of income (such as letter of reference from one the following: Employer, Minister/Priest, etc. on a company or official letterhead)
• Proof of Family Size:
  • Patients must declare their legal spouse and any minor children when applying for sliding fee discounts. If other individuals are included in the household and are not minor children, additional documentation may be required to verify legal and financial responsibility.
  • Acceptable documentation includes, but is not limited to:
    • Adult Children (under age 26):
      • Proof of school enrollment and/or
      • Prior year’s federal income tax return showing the individual claimed as a dependent.
    • Other Dependents or Non-Minor Children:
      • Legal documentation indicating responsibility for the individual, such as:
      • Court-ordered guardianship papers
      • Custody agreements
      • Foster care placement letters
      • Other official decision letters or legal orders
      • Federal Income Tax Return (Form 1040): A copy of the most recent return that lists all dependents claimed, which serves as verification of family size and financial responsibility.

All patients are required to recertify their Sliding Fee Scale eligibility annually (from the date of first application).

Self-Employed

Please bring the following documents once a year:

• Current Photo ID (If you do not have a Photo ID, see our front desk for assistance)
• Most recent federal tax return with Schedule C to verify income

Unemployed

Please bring the following documents once a year:

• Current Photo ID (If you do not have a Photo ID, see our front desk for assistance)
• Unemployment insurance wage determination from the Georgia Department of Labor and the most recent federal tax return to verify income and/or a current 30-day separation notice

Homeless

Please bring the following documents once a year:

• Current Photo ID (If you do not have a Photo ID, see our front desk for assistance)
• Patient will be asked to sign a Certification for Homeless Form to certify present situation

No Documents Available

Please bring the following documents once a year:

• Current Photo ID (If you do not have a Photo ID, see our front desk for assistance)
• Patient will be asked to sign a Self-Attestation of Income Form to certify present situation

 Billing Questions

 Additional Services

Educational Websites

Visit healthfinder.gov for quick and easy information and tools to help you stay healthy.

For more specific information on health topics, please visit the following sites:

• Centers for Disease Control and Prevention (CDC)
• American Heart Association
• American Diabetes Association
• American Dental Association
• American Psychological Association
• Georgia Primary Care Association
• Health Resources and Services Administration