Please arrive 15 minutes prior to your scheduled appointment and bring:
- Insurance card
- List of medications you regularly take
- Immunization record
- Appropriate income support documentation, if you want to apply for the Sliding Fee Discount Program. For a detailed list of approved documentation, please see the Sliding Fee Discount Program application.
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)
- Release of Information Form (PDF Version)
- General Authorization for Disclosure of Health Information (PDF Version)
- HCH Enrollment Form (Microsoft Word Version)
- Affidavit of Financial Status (Microsoft Word Version)
- Welcome Brochure / PCMH Information (PDF Version)
Sliding Fee Schedule
As a Federally Qualified Health Center, PureView Health Center 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 the Sliding Fee Discount Program.
- Sliding Fee Discount Program Application (PDF Version)
What Will I Pay?
PureView treats everyone regardless of income or insurance status. We offer a sliding fee schedule 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, regardless of their insurance status.
Our Sliding Fee Discount Schedules are based on income and family size.