Welcome to Health Partnership Clinic! We want to be your home for medical, dental and behavioral health care. We do everything we can to help you get the care you need when you need it – whether you are insured or not.
To become a patient, please follow these steps:
- Schedule an appointment – three options:
- Complete the forms below and bring them with you.
- Your initial appointment will be with our Patient Financial Aid Coordinator. Once your appointment with the Financial Aid Coordinator is complete, she will schedule an appointment for you to be seen by a medical provider.
- Bring with you:
- Insurance card
- Photo ID
- Proof of address
- If not insured, documents showing one month’s worth of household income.
- Most recent paystubs to equal 30 days
- Most recent annual federal income tax return
- Documentation of government assistance:
- Unemployment compensation
- SRS cash assistance
- Social Security or SSI
- Disability determination with benefit amount
- Documentation of child support/alimony
- Letter on employer letterhead, signed and dated by supervisor
- Financial award letter showing grants, scholarships, fellowships, or assistantships (Loans are not considered as income)
- Self-Employed: Submit detail of the most recent three months of income and expenses for the business.
Adequate information must be made available to determine eligibility. Please submit a notarized letter from the individual assisting you financially and include the monthly monetary amount provided. In addition, we are unable to accept W-2s.
Review Before Your First Visit:
Notice of Privacy Practices
Notificacion de Practicas de Privacidad
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.