Road Map for Appointments
What do I need to bring to my Eligibility Appointment?
Please bring the following important documents:
Identification– bring one of these for each related adult and child in the household:
- Adult: Driver’s license, ID card, passport or immigration documents
- Child: Birth certificate or school records
Proof of income– bring at least one of the following for all income sources in the household:
- Paycheck stubs (most recent full month)
- Social Security documents
- Tax returns
- Letter of employer stating pay rate
- Statement of financial support from any other source of income
Proof of Address– bring at least one of the following:
- Mail with your name
- Lease agreement
- House payment coupon
- Voter registration
- Utility bill
What if I don’t qualify for program-based assistance?
During your eligibility appointment, we will match your personal circumstance to all available programs and determine which is most appropriate for you. If you do not qualify, we may be able to offer other options that reduce the cost of your care.
What else should I know about these programs?
- You must provide information annually to maintain your eligibility.
- Falsifying information may result in loss of discounts, and full fees may become due.
- The use of services will not be reported to third parties.
Patient Intake and Eligibility Forms
Requesting Medical Records
Please call our Medical Records department at (713) 660-1880 ext. 1420 for additional information.