To Become A Patient

To become a patient of the Gary Burnstein Community Health Clinic you must be:

• 18-65 Years old
• a Michigan resident
• at or below 250% Federal Poverty Level, click here to see if you fall within these guidelines:
• uninsured

If you meet the above criteria and would like to become a patient please bring the following to the GB Community Health Clinic:

• Supply your most recent financial information as one of the following
  • 1040 or 1040ez (tax return)
  • Proof of non-filing status from the IRS For those who did not file taxes last year or have no income.
    • The IRS can be reached at 1-800-829-1040
  • Supply a valid, government issued, picture ID (drivers license, state ID, prison ID, or green card)
  • Letter of Denial from Medicaid
  • Completed Patient Registration
  • Completed Patient History
  • Completed Patient Consent Contract
  • Completed Release of Medical Information
  Download the application here Intake Packet

  If you have any questions, or need help please contact Patricia at phone # 248-309-3752. She can be reached M-F 9am-12pm. If she is not available please leave a message, she will normally call back within 24 hours.