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Patient Information

How Do I Make An Appointment?

To make an appointment, simply contact our center during office hours. When making an appointment, be sure to have the following information available.

  • Reason for the visit including any forms that require completion
  • Whether you are a new or existing patient
  • Health Insurance Information – if you don’t have health insurance, please be sure to inform our staff who can help you apply for our sliding fee program

Preparing For Your Appointment

We believe that good health and peace of mind begins with a quality relationship between our medical professionals and you, the patient. We want your experience at our facility to be as pleasant and as easy as possible, whether you are a new or an existing patient. We have prepared a checklist of some Frequently Asked Questions as well as what you will need for your appointment. If you have any additional questions, please contact us, our staff will be happy to answer any questions that you may have.

What Do I Need To Bring To My Appointment?

On the day of your appointment, please arrive at least 15 minutes early, especially if this is your first appointment since you will need to register and/or update information. The following information will be required to complete your patient registration:

  • A valid photo identification, such as a Driver’s License, State Identification Card,  Passport, or Veteran’s ID
  • Your current contact information, which includes your address, phone number and email address
  • Current contact information for emergency contacts
  • Any Medical Card or Insurance Card
  • Any prior medical records that you have
  • A list of any medications that you are currently taking – we encourage you to bring the medications and any supplements that you are taking.
  • A list of any concerns that you have that you wish to discuss during your appointment
  • If your visit includes completion of any forms, please bring them with you.

The following forms must be completed prior to new patient appointments and are updated annually. Please print them out, complete them and bring them to your visit. These are required for each individual patient and are not family forms. Completing the forms in advance of your visit will save time.

Welcome!

UDS form 2021

Consent to Treat

Privacy Practice Acknowledgement

Privacy Practices

What if I Don't Have Insurance?

If you do not have a medical card or insurance, the following information is needed to determine your eligibility for support programs and/or sliding fee scales:

  • Birth certificate or passport
  • Photo identification (driver’s license, state ID, school ID)
  • Medicaid, Medicare, or commercial insurance card (if applicable.) Medicaid denial letters for anyone in the household.
  • Proof of current residence (e.g., utility bill, bank statement, phone bill)
  • Last year’s federal tax return (1040 form) or waiver of filing (From 4508-T)
  • Paycheck stubs for most recent 30 days (if employed.) If you (or someone in your household) works but do not have pay stubs, provide a signed letter from your employer on the employer’s letterhead (with contact name and phone number) and the amount you are paid.
  • Proof of any other sources of income, unemployment, Social Security

Good Faith Estimates

Beginning January 1, 2022, you have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes medical, dental, and mental health visits and related costs like medical tests, lab services, and dental procedures.

Sto-Rox Family Health Center and Hilltop Community Health Center will give you a Good Faith Estimate in writing at least 1 business day before your appointment by secure email or postal mail. You can also ask us, and any other provider you choose, for a Good Faith Estimate before you schedule an appointment.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Make sure to save a copy or picture of your Good Faith Estimate. For questions or more information about your right to a Good Faith Estimate visit here.

What if I need to speak to a provider after regular clinic hours?

Simply call the regular phone numbers for the clinic and your call will be routed to our answering service. Calls will be sent to the on-call provider. Coverage is provided 24/7.