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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

  •   Must not qualify for public or private insurance (i.e. Medicaid, Medicare, NC Health Choice,   Disablity or Veterans’ Benefits).

  •   Must be Permanent Resident of Wake County.

  •   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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2/1/23-3/31/23                 1.  2022 W2 & 3 2023 Paystubs for all working household members 

                                            2.  Letter of Support - Notify Mariam Clinic & we will provide this form

                                            3.  Income Verification Form - Notify Mariam Clinic & we will provide this form

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5/1/23-5/31/23                 Tax Form 1040 for 2022

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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.    Walkin: 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

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