Annual Requalification - Existing Mariam Clinic Patients
Each year all existing Mariam Clinic patients are required to go through a re-qualification process. To re-qualify please read the eligibility requirements below and submit the required documents outlined in the "Required Documents" section below along with the Intake Form.
Requalification Requirements
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Must not qualify for public or private insurance (i.e. Medicaid, Medicare, NC Health Choice, Disablity or Veterans’ Benefits).
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Must be Permanent Resident of Wake County.
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Household income no more than 200% of the poverty level (to view poverty level, click here).
Required Documents
Due Date Required Documents
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Due March 1 Previous year W2 & 3 most recent paystubs for all working household members
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Due May 1 Previous year Tax Return (1040). Include Schedule C for self employed.
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How to submit your documents
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1. Mail: Mariam Clinic 4441-106 Six Forks Rd Ste 388 Raleigh NC 27609
2. Walk-in: drop your documents off at the front desk on Sunday
3. Email: director@mariamclinic.org - PDF only, no photographs
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If you are unable to provider the required documents by the deadline please contact the clinic 919-824-4672