Become a Patient

If you’re unsure if you are at or below 250% of the Federal Poverty Level click here to see if you fall within the guidelines.

Please bring the following to the GBCHC for your first visit.  If you do not have all these documents, or have questions, we can help.  Call us at 248-309-3752.

• 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
• Intake Packet linked on this page (which includes the following:)
  • Patient Consent Contract
  • Patient Registration Form
  • Optional: Disclose protected health information
  • Patient medical history
  • Signed notice of privacy practice

If you meet all of these criteria, please complete the necessary paperwork for the services you require. 

If you have any other questions, or need help please contact the office at (248) 309-3752. Office hours are Monday through Friday, 9 am – 4 pm. If no one is available, please leave a message – the Clinic will do everything we can to get back to you within 24 hours.

Clinical medical services provided by the Dr. Gary Burnstein Community Health Clinic are entirely free of charge to our patients. Medical appointments are normally within a few days of receiving all the paperwork.