In order to receive discounted services, all patients must file an agreement for discounted services (see below). This form must be filed ANNUALLY in order for discounts to continue. Patients must bring this form along with one of the following documented proof of income (POI).
Types of Proof of Income Documents:
If all documentation is not provided at the time of care patients may not be eligible to receive discounted services.
Also, services are not retroactively discounted. All services provided to patients must be paid for in full.
Income Sheet Click Here
Hoja de Ingresos Clic Aquí
Form for Discounted Services:
In order to receive discounted services, the following form must be filled out. Patients can print and fill out information at home, or can elect to fill out all forms at the time of visit. Filling forms out before the visit will speed up the length of time it takes to see the provider.
Discount for Services Documentation Acknowledgement Click Here
Carta de Documentación para Servicios al Descuento Clic Aquí
Decline of Discounted Services - No Discount Click Here
Rechazo por servicios descontados (Sin descuento) Clic Aquí
Don’t see yours listed? We contract with most insurance providers. Please check with your insurance company to find out if we’re on your plan.