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New Patient Registration

We DO NOT take Walk-In Eligibility Screening Patients.
Call us today to schedule your Eligibility Assessment Appointment. 

First Patient Visit

Prepare for Your Scheduled Appointment

Thank you for choosing Samaritan Health Ministries as your new medical home.

Making an appointment is easy and convenient. We have one central phone number that enables you to make appointments for all our services.

Before your eligibility assessment appointment, you can save time by filling out the patient registration forms, preparing the documents and following the listed steps below.

 

We want your experience to be as easy and comfortable as possible. If you have any questions, please feel free to call us.

01

Call to Schedule Your Eligibility Appointment

We require an assessment prior to providing services to our patients. During your call or in-person visit with us, you will be interviewed, either by phone or in person at our clinic, by one of our financial screeners to determine income level and family size before you can be seen by a SHM provider.

02

Prepare Required Documents to Bring with You 

Before your eligibility assessment appointment you can save time and multiple appointments by filling out the patient registration forms listed below.

Please bring the following to your first appointment:

  • Current photo ID. (cannot be expired)

  • Proof of address. (utility bill, auto insurance, voter registration, government issued document)

  • Proof of combined household income for the past 30 days. (pay stubs, W2, current tax return, unemployment benefits, SS benefits, child support/alimony)

03

Download Patient Application and Fill Out Form

Please download and print the Patient Application PDF form (English) or the Patient Application PDF form (Spanish), fill out and bring to our offices with you to your scheduled appointment.

04

Provide Additional Proof of Income and Address

To help expedite your visit with us, please have the following information ready.

Proof of income can also include:

  • Paystubs reflecting a 30 to 60 day period. 

  • Employer's written verification of gross monthly income or the Employment Verification Form (Form 128).

  • Income tax return.

  • Printout of child support payments.

  • Statement of support from relative or friend providing financial support. 

  • Unemployment benefits statement or letter from the Texas Workforce Commission.

  • Award letters, court orders, or public decrees to verify support payments. 

  • Notes for cash contributions. 

Proof of address can also include:​

  • Current voter registration

  • Rent or utility receipts for one month

  • Car registration

  • School records

  • Property tax receipt

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