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Current Patient Resources

If you are a current patient on Project Access and you need to re-enroll please use the following forms below. You must provide current proof of address and income with your re-enrollment form. (See acceptable sources of proof document below)

PLEASE NOTE: If your enrollment expired more than 30 days ago, you will be required to complete a NEW application. Please visit the "new patients resources" page to complete the correct application.

RE-ENROLLMENT FORMS

Re-enrollment Application (PDF) Re-enrollment Application (PDF)

Re-enrollment Application (Fillable PDF) Re-enrollment Application (Fillable PDF)

Zero Tolerance Updated 8-8-17 Zero Tolerance Updated 8-8-17

Acceptable Sources Of Proofs (PDF) Acceptable Sources Of Proofs (PDF)

Patient Responsibility Form (PDF) Patient Responsibility Form (PDF)

No Income - Transient Form (PDF) No Income - Transient Form (PDF)

Contributions Form (PDF) Contributions Form (PDF)

Self Employment Form (PDF) Self Employment Form (PDF)

Once you have completed the re-enrollment application you may email it along with your acceptable proof documents to projectaccess@medicalbureau.net, submit it by mail to Project Access - 2612 Commons Boulevard - Augusta, GA 30909 or via fax to (706) 736-8055. If you have questions concerning your re-enrollment please call (706) 733-5177.

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  • Home
  • Goals And Objectives
  • Services
  • Officers
  • By-Laws
  • Partners And Volunteers
  • History
  • Photo Galleries
  • Contact
  • APPLY NOW