Patient Requirements
To be seen at the Smith Family Wellness Center, you must:
1. Live in Mecklenburg or surrounding counties
2. Be uninsured or underinsured
3. Provide proof of income
4. Please call (704) 910-5810 for the next new patient screening date and time.
What to Bring with You
Bring a completed application and copies* of the following items:
1. Picture ID
2. Social Security card, if available
3. Proof of Income- can be one of the following:
1. Two (2) consecutive Payroll stubs (most recent)
2. A letter from their employer
3. Previous year tax return (1040)
4. Proof of residence: Utility bill (cable, phone, electric, etc.) with patient name and
current address
*Please bring copies of all supporting documentation, copies will not be made at clinic.
To be seen at the Smith Family Wellness Center, you must:
1. Live in Mecklenburg or surrounding counties
2. Be uninsured or underinsured
3. Provide proof of income
4. Please call (704) 910-5810 for the next new patient screening date and time.
What to Bring with You
Bring a completed application and copies* of the following items:
1. Picture ID
2. Social Security card, if available
3. Proof of Income- can be one of the following:
1. Two (2) consecutive Payroll stubs (most recent)
2. A letter from their employer
3. Previous year tax return (1040)
4. Proof of residence: Utility bill (cable, phone, electric, etc.) with patient name and
current address
*Please bring copies of all supporting documentation, copies will not be made at clinic.
