New Patient Packet – If you have scheduled a new patient visit.  Please print out the following documents, complete and bring to your appointment.

·         Registration Form – link

·         Payment Policy & Patient Responsibility - link

·         Release of Information – link

·         Privacy Practices - link

·         Health History Form- link

Resources for the Uninsured –

Financial Assistance:   If you are uninsured, you may quality for financial assistance up to 50% off of your services.  Eligibility and discount amount is based on household income and size.  If you would like to apply for financial assistance, please print out the following attachments and return to the clinic with your proof of income. The forms can be mailed or dropped off.

·         Application for Financial Assistance - link

·         Instructions for Completion - link

Medication Assistance:  There are many drug companies that off medication at little to no charge.  To qualify for the programs, you must have no prescription benefits and meet the income guidelines.  The eligibility guidelines vary from medication to medication.  If you do not have prescription coverage and are interested in applying for medication assistance, please print out the following attachments and return to the clinic with your proof of income.  The forms can be mailed or dropped off.

·         Application for Medication Assistance - link

·         Instructions for Completion- link

Discounted Lab Work:  Two hospitals in the area provide lab work to the uninsured at a discounted rate.  If you are interested in more information, please contact the clinic at 503-665-1010.

Options for Making Payments – There are several options for making a payment on your account.  You may pay by cash, check, or credit card.  Payments can be made in person at the clinic, by telephone, by mail, or online. 

To make a payment online, please click on the link below:

Link