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:

  1. Schedule an appointment – two options:
  1. Complete the forms below and bring them with you.
  2. 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.
  3. Bring with you:
  • Patient ServicesInsurance 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.

Patient ServicesAdequate 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.

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Patient Forms 

When you arrive for your first visit, please have the forms below filled out. Also, please bring any additional documents needed (ID, insurance card, etc.) These will be collected at check-in. You can print these PDFs off at your convenience, and we also offer paper copies in our offices.

Complete and Return the PDF forms below on or before your first visit.

Watch this video to learn about how to establish care with Health Partnership!

Homeless Patients
(PDFs – English)

Homeless Patients
(PDFs – Spanish)

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Outreach-Based Patients (School/Community)

Patient ServicesComplete and Return Before Your Child’s First Outreach Visit:

We are working with Hellosign to help you securely complete forms online.

You can complete this form online.

    • To get started you’ll need a web browser (like you’re already using) and an email address.
    • After clicking on “fill out a form,” you’ll be taken to Hellosign’s website where you will be prompted to enter an email address.
    • The email address you enter will receive an email (check your spam or junk folder if you don’t see it!). Just click on “Review document” and begin completing the form.
    • Once you’re finished, hit “I AGREE.” You’ll receive another email with a link to view your completed form, if you wish.
    • Your child’s name will be added to the school list. Our dental team will see your child on the next scheduled visit to your school.

Insurance + Other Services
We can help you apply for a Health Insurance Marketplace plan or for Medicaid/KanCare. And we can help you apply for our Sliding Fee Discount.

Patient Portal 

Payment Options