Please arrive 15 minutes prior to your scheduled appointment and bring:
- Insurance card
- Current paycheck or tax documents
- List of medications you regularly take
- Immunization record
To better serve you, we provide the following new patient forms on-line. To find the forms, please click on the appropriate button. Then print out the form, fill it out and bring it with you when you come for your appointment.
The following forms are in the Portable Document Format (PDF) and require Adobe’s Acrobat Reader.
- Patient Information – PureView Health Center (PDF Version)
- Patient Information – Parker Medical Center (PDF Version)
- Release of Information Form (PDF Version) (Microsoft Word Version)
- HCH Enrollment Form (PDF Version) (Microsoft Word Version)
- HCH Affidavit of Financial Status (PDF Version) (Microsoft Word Version)
- Welcome Brochure / PCMH Information (PDF Version)
Sliding Fee Schedule
As a Federally Qualified Health Center, PureView is able to offer most services on a sliding fee scale. This means that depending on your family income and family size, you may be eligible for greater discounts.
What Will I Pay?
PureView treats everyone regardless of income or insurance status. We offer a sliding fee schedule affordable sliding fee scales to patients who fit certain federal income guidelines. Patients who fit these guidelines are eligible for the sliding fee scale once they provide proof of income.
To see where your income falls according to the federal income guidelines, click here.
This sliding fee scale is used to discount all out-of-pocket costs.