Become a Patient

We are currently accepting new patients!

Patient eligibility requirements:

  • 18 years or older
  • Resident of Wake County
  • No health insurance
  • No Medicaid
  • No Medicare
  • Employed or live with a family member who is employed in Wake County

How to Become a Patient:  

If you would like to become a patient at Alliance and meet the eligibility requirements listed above, you will need to complete a Patient Application and deliver it to Alliance before being scheduled for an appointment. The information will be reviewed and you will be contacted to schedule an appointment. 

Patient Application – Download:  English Application   or Spanish Application:

In order to apply to become an Alliance patient, you must complete ALL of the following in numbers 1-9 and submit to Alliance's Patient Services: 

  1. COPY of a current Government issued photo ID (Driver’s license, Green Card, VISA, etc.).
  2. COPY of proof of Wake County residency (utility bill, telephone bill or property tax bill).
  3. COMPLETED Patient Information Form (Patient Application)
  4. COMPLETED Health History Form (Patient Application)
  5. SIGNED Patient Responsibility and Accountability Contract (Patient Application)
  6. SIGNED Medical Release Form (Patient Application)
  7. SIGNED Limited Power of Attorney (Patient Application)
  8. Proof of income source A (one of the below) 
    1. Tax Form 1040 OR
    2. Tax Form 4506-T - Download: English PDF
  9. Proof of income source B (one of the below)

    1. OPTION 1:  One month of current consecutive pay stubs from any household member

    2. OPTION 2:  If a patient does not receive pay stubs, a notarized letter from their employer with contact information stating weekly or monthly income

    3. OPTION 3:  If income is direct deposited, a bank statement showing a month's worth of direct deposit

    4. OPTION 4:  If patient is self-employed, six (6) months worth of bank statements showing income deposits which may be averaged to compute income.

How to Make an Appointment: 

All appointments in our primary care clinic must be scheduled. If you are an established patient at Alliance and want to make an appointment, please call 919-250-3320 and follow the prompts.  If you are a new patient and have delivered your completed patient package to Alliance, you will be contacted by our Patient Services upon review and approval to set up an appointment.

Requirements for first appointment:

  • Arrive 15 minutes before scheduled appointment
  • Must bring all current medication
  • Must bring co-pay.  *Payment is expected at time of service. The average co-pay is $25. We accept cash, personal checks, and Mastercard & Visa debit cards.*

You will receive your Alliance card at your first appointment, which you must bring with you to all future appointments.

 

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