Patient Information
Good Samaritan Health & Wellness Center – Jasper, GA
Patient Forms
Patient Information Disclosure
(from Good Samaritan)
Patient Information Disclosure
(from Others)
Patient Paperwork – Adult
(Renewal)
Patient Paperwork – Pediatric
(Renewal)
Sliding Fee Scale Discount Program
Payments Accepted
Good Samaritan is a Federally Qualified Health Center and we offer a Sliding Fee Discount Program for those that have no insurance or are under-insured. The Sliding Fee is based on a patient’s family size and documented gross household income.
We also accept Medicare, Medicaid, Veterans Choice and most private insurance plans including:
- Aetna (Commercial and Medicare)
- Amerigroup
- Anthem BCBS
- CareSource
- Humana (Commercial and Medicare)
- Medicaid – Georgia
- Peach State
- Medicare
- MultiPlan
- United Healthcare
- Wellcare
Cash, credit, and debit cards are accepted. Payment is required at the time of service.
Clinic Hours: Monday, Tuesday, Wednesday & Friday: 8:30 am to 5:00 pm | Thursday: 8:30 am to 8:00 pm
Pharmacy Hours: Monday, Tuesday, Wednesday & Friday: 9:00 am to 5:00 pm | Thursday: 9:00 am to 8:00 pm
Pharmacy is closed for lunch from 1:00 pm to 2:00 pm every day.
Good Samaritan
Health & Wellness Center
175 Samaritan Drive
Jasper, GA 30143