What do I need to bring?
- State Issued ID
- State Issued Drivers License
- Private Health Insurance Identification Card
- OR Medicaid card
- OR Medicare card
- Income tax returns for the past year with W2’s and Schedules
- OR Three (3) most recent paycheck stubs for each working member of the family
- OR Unemployment check stub or the determination letter
- Workerman’s Compensation (SSI) Income
- SSI (Supplemental Security) Income
- Child Support or Alimony
- Full time student documentation (verification letter from school with credit hours and expiration date)
Notice:
Patients who fail to produce the appropriate documentation for the Uninsured Sliding Fee Schedule will be informed that they are 20% pay patients. Any patient, who fails to provide the required documentation at their next visit will be required to pay full price.
