To Become A Patient

To become a patient please bring the following to the Gary Burnstein 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.

 

We are located at:

45580 Woodward Ave
Pontiac, MI 48341
(248) 309-3752