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
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
5/1/23-5/31/23 Tax Form 1040 for 2022
How to submit your documents
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
If you are unable to provider the required documents by the deadline please contact the clinic 919-824-4672