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How to become a New "Mariam Clinic Patient"

 Eligibility Requirements

Required Documents

  • Ages 18 and above

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

  • Permanent Resident of Wake County.

  • Household income no more than 200% of the poverty level (to view poverty level, click here).

If you do not meet the requirements to be seen at Mariam Clinic, please visit NC Free Clinics to find another clinic to meet your needs.

  • A copy of your non-expired Photo ID. Also a copy of your Green Card or Visa if you have one. If your ID does not have current address you will need to bring in a utility bill or some other bill to establish Wake County residency.

  • 3 most recent paystubs for all working members of the household.

  • Tax Form 1040 (pg1 & pg 2 only) for all working members of the household. If self-employed please provide Schedule C.

  • If someone is supporting you, Mariam Clinic will provide you with a Letter of Support form

If you are eligible, please mail the required documents to

       Mariam Clinic

       4441-106 Six Forks Road #388

       Raleigh, NC 27609

You can also email them to:

  **please note that they must be in pdf format;  emailed JPEGS can not be accepted **

  • Include your contact number and email.


  • Your documents must be received by the clinic before you can be registered as a patient. You will be contacted by staff once your documents are reviewed, your appointment and new patient paperwork will then be created, you can't make an appointment to be seen on this website

  • If you do not have all the required documents listed above or need help with the application process please call us at 919-824-4672.

If you are a refugee whose medicaid has expired and need help with the application process please call 919-824-4692.

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