Our Patients

Becoming a Patient of Community Care Center

We’re excited to welcome you! Here’s how to become a patient:

Initial Screening

To start, you’ll need to come in for an eligibility screening and get approved before using our services.

About the Community Care Center:

• Appointments Only: We’re not a walk-in clinic, so please make an appointment.
• Volunteer Staff: Our amazing team of volunteers generously gives their time.
• Support: We’re funded by contributions from individuals, churches, businesses, foundation grants, and patient donations.

Please Note

• We don’t provide emergency care.
• We don’t offer care for pregnant women.
• We can’t meet every medical and dental need.
• Your personal information is confidential and shared only with your care providers.

Eligibility Requirements

To qualify, you need to:

• Have lived in Forsyth, Stokes, or Davie Counties for at least the last three months.
• Not be eligible for state or federal healthcare insurance (including Veterans Administration, Medicaid, or Medicare).
• Not be eligible for healthcare insurance through your employer.
• Provide all necessary information and meet our financial guidelines. We aim to make this process as smooth as possible to ensure our resources go to those who need them most.

How to Apply

Screening Times: Eligibility screenings are held every Tuesday and Wednesday from 1:00 PM to 3:00 PM. No appointment is needed for the interview.

What to Bring to Your Interview

Proof of Identity:

• You will be asked to provide a photo ID (government or job issued) at your
  interview.

Requirements for Children:

• Birth certificate and/or vaccination records for children born outside the U.S. and
  living in the home.
• Medicaid/NC Health Choice cards for all children born in the U.S. and living in the
  home.

Proof of Address (Choose one below):

• Required for every adult in the household, even if they are not applying to be a patient.
• NC driver’s license, learner’s permit or
  state issued ID
• Current utility bill with name/address
• Bank statement with name/address
• Current Social Services letter
• Lease agreement or mortgage statement with the address of the residence, your name and your landlord’s name and address, signed and dated
• If you are homeless, your shelter must provide us with a letter, on letterhead, stating that you stay there.

 Proof of Income (ALL that Apply):

• Copy of the last month’s pay stubs for ALL people working in the household, even if they are not applying to be a patient.

• Federal tax return and last two pay stubs

• Proof of disability or retirement benefits (letter from SSI). If this is direct deposit, you must bring your last two bank statements and proof that you
  are NOT eligible for Medicare,

• If you are paid in cash, the employer must fill out a Wage Verification Form, which can be obtained from the Community Care Center. We may call
  the employer to verify this information.

• Unemployment benefits statement

• If you are self-employed, bring your accounting books or a copy of last year’s taxes, including Schedule C.

• If you are living on savings, you must provide the last three months of bank statements.

• Child support

• SSI benefits for children with deceased parents

• If you have no income, we require a letter of support from the person who provides you with food and shelter. In addition, that person MUST provide proof of their current income, even if they do not live with you.

Proof of Expenses:

• Title or car registration and monthly bill for all cars not paid for
• A lease or mortgage statement
• All monthly bills (even if they are not in your name)
• Utilities, including power, gas, and water, as applicable
• Cable/Internet
• Phone
• Credit Cards
• Daycare
• Car Insurance
• Etc.

PLEASE NOTE:
You will NOT see a doctor the same day you come to your interview. Instead, once you complete your interview and are approved, you wait until the following Monday to call, receive your patient number, and make an appointment for a later date.

Patient Applications

• Click to View Patient Application in Spanish
• Click to View Patient Application in English

Appointments

Making an Appointment

Once approved, you’ll receive an ID card and medical record number. Please have your medical record number handy when scheduling an appointment. 

Contact Us

Appointments can be made by calling (336) 723-7904 or visiting us in person Monday through Thursday from 9:00 AM to 5:00 PM. 

Dental Appointments

Currently, we’re not accepting new dental patients. Please ask about being added to the waiting list. 

Specialist Referrals

Primary care physicians will work with you to determine if you need a specialist and make the referral. 

Cancellations

If you can’t keep your appointment, please let us know right away so we can offer that time to another patient. Missing appointments without notice may affect your eligibility for services.

Expectations of Patients

To help us serve you better, we kindly ask you to:

• Be on time for your appointments.
• Request medication refills before you run out, as our doctors are available only during clinic hours.
• Bring your medications in their original prescription containers to each visit.
• Keep appointments with external providers if referred.
• Supervise your children closely for everyone’s safety.
• Help us maintain a clean clinic environment.
• Treat our staff and volunteers with politeness and respect. We strive to create a welcoming atmosphere for everyone.

Thank you for your cooperation and understanding!

Patient Application

Completing as much of the attached documents as possible will speed up the processing of your application.

• Patient Application in Spanish
• Patient Application in English