Become A Patient
The Health & Wellness Center offers the availability to self-check-in up to 48 hours prior to appointment time. To use this feature, please request advanced check-in at the time of scheduling your appointment.
The Health & Wellness Center encourages its patients to participate in its Patient Portal. This portal can be used to Securely communicate with the Care Team; request medication refills and view lab results. To register, the health center will require a valid email address, please contact a staff member for assistance.
STEP ONE:
Request an Appointment
Click here to fill out our "Request an Appointment" form and a representative will contact you to complete the registration process.
STEP TWO:
All patients should review our Welcome Packet that explains both Health & Wellness Center and patient responsibilities and obligations. Upon arriving, you’ll be asked to confirm that you’ve received the information contained in this packet.
Welcome Packet
English Version
Welcome Packet
Spanish Version
STEP TWO:
To prepare for your first visit, save time by completing the following forms:
1
In order for Health & Wellness to treat a patient, the patient must complete a registration packet.
Insurance Cards & Photo ID’s must be presented at the time of visit
Registration Packet
English Version
Registration Packet
Spanish Version
2
Required for patients under 18, we must have the name(s) of individuals who may bring the child to our facilities. By default, the parent or guardian listed on the Registration Packet can bring an underage patient to our facility. If anyone else (Grandparent or other caregiver) will be allowed to bring the patient in, we’ll require the Permission to Authorize Medical Care form to be completed. If no one other than the Parent/Guardian will be allowed to bring the patient to our facility, then the Permission to Authorize Medical Care form should indicate “NONE”.
Permission to Authorize
English Version
Permission to Authorize
Spanish Version
Other Forms
Health & Wellness offers a sliding fee for uninsured and under-insured patients. This fee is household income based and will require supporting proof of income documentation. Download a Sliding Fee Application. Approved supporting documents can be found on this page.
In order for Health & Wellness Center to share your health information with your loved ones, we’ll require: Consent of Protected Health Information form to be completed. This is an optional form, but required by law should you wish us to communicate your health information with spouses, grandparents, children or other individuals.
Sliding Fee
Application
English Version
Sliding Fee
Scale
English Version
Sliding Fee
Application
Spanish Version
Sliding Fee
Scale
Spanish Version
Consent of
Protected Health
Information
English Version
Consent of
Protected Health
Information
Spanish Version
If you’re visiting a department other than Medical, there may be additional paperwork that can be completed while you wait for the provider.
Behavioral Health
English
Behavioral Health
Spanish
New Dental Patient
English
New Dental Patient
Spanish
Medical Records
Release
English
Medical Records
Release
Spanish
New Patient Medical Form
English Version
New Patient Medical Form
Spanish Version
New Patient Optometry Form
English Version
New Patient Optometry Form
Spanish Version
In compliance with the No Surprises Act, the Health & Wellness Center offers Good Faith Estimates to Uninsured patients for appointments scheduled 3 or more days in advance. Good Faith Estimates will be sent from the Health & Wellness Center (HWC) within 24 hours of scheduling an appointment or specifically requested.
Good Faith Estimates will be determined based on the described chief complaint at the time of scheduling an appointment. The health center will, to the best of its ability, provide detailed codes and related cost of service. Good Faith Estimates will be valid for no longer than one (1) year from the date of publication. If actual costs exceed $400 of the estimate, patients may request reconsideration of actual charges or request independent arbitration.
HWC kindly requests patients to enroll in the Patient Portal for the most efficient delivery of Good Faith Estimates. This portal also includes access to additional Health Information including Lab Results, Current Medications and the ability to Securely communicate with your provider.
