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.
All established Alliance patients are required to renew their eligibility annually.
Step 1: Download and complete a Patient Application:
Note: Your Patient Application must be completed in full, including:
- Patient Information Form
- Health History Form
- Signed Patient Responsibility and Accountability Contract
- Signed Medical Release Form
- Signed Limited Power of Attorney
Step 2: Gather these additional documents:
Copy of a current Government issued photo ID (Driver's license, Green Card, Visa, etc.)
Copy of proof of Wake County residency (utility bill, telephone bill, or property tax bill)
- Proof of income source A (one of below)
- Proof of income B (one of below)
- Option 1: One month of current consecutive pay stubs from any household member
- Option 2: If a patient does not receive pay stubs, a notarized letter from their employer with contract information stating weekly or monthly income
- Option 3: If income is direct deposited, a bank statement showing a month's wort of direct deposit
- Option 4: If patient is self-employed, six (6) months worth of bank statements showing deposits which may be averaged to compute income
Step 3: Patient Responsibility and Accountability