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New Patient Application

Thank you for applying to be a patient at Mercy Medical Clinic.

The following documents will be needed at your initial intake appointment:

  1. All documents for proof of income (tax returns, food stamps benefit letter, 3 months of current check stubs if you or your spouse is employed)

    If you do not have any income, you will be asked to complete a “Support Letter” at your visit
  2. A copy of your picture i.d.
  3. A copy of your social security card