1. Becoming A Patient

Our patients are encouraged to be active partners for managing their health and building healthy communities.

• Call to make an appointment at 504.533.4999.
• Arrive 10 minutes before appointment (15 minutes for new patient registration) to help us keep your information accurate and up-to-date, so you can see your provider in a timely manner.
• You can also print and fill out “Patient Registration Form” in advance to facilitate your registration as a new patient.

Please bring the following documents on your visit:

• Photo ID
• Insurance card(s), including Medicaid and Medicare at every visit
• Proof of income and address. If you currently are uninsured or underinsured, you may be eligible for our sliding fee scale (see Sliding Fee section below). Provide one of the following: prior year tax return, recent pay stubs, pensions, social security benefits, disability, veteran’s benefits, unemployment compensation, retirement, child support or alimony payments, letter with balance on Electronic Benefit Transfer (EBT) card, or reference letter If income is paid in cash, please provide a letter from employer to include the current date, date hired, employee’s name and address, employer’s name/address/phone number, wages per hour and how many hours of work per week, and frequency of pay period. The letter must be signed and dated by the employee and employer.
• For your children, please bring immunization record
• Current medications
• Nominal fee

If you fail to bring the required documentation, your appointment will be rescheduled.

We value your appointment and trust you respect our time, so if you must cancel…

• Please notify the clinic as early as possible, preferably at least 24 hours prior to the appointment.
• Failure to keep your appointment may result in a delay of rescheduling.
• If you are late for your appointment, your medical provider may ask that you reschedule.

Forms

• Patient Registration Form
• Sliding Fee Application Form
• Patient Update card
• Patient Satisfaction Survey

2. Sliding Fee

BCHS offers a sliding fee scale based on family size and income. Proof of income and family members are required to complete the application process.

Application for sliding fee discount is available for download (pdf) \

The following documents are required:

1. Photo ID and address verification – one of the following

• Current photo ID with address
• Current photo ID with any utility bill
• Other business documents that verified your place of residency

2. Proof of income

Provide one of the following: Prior year tax return, recent pay stubs, pensions, social security benefits, disability, veteran’s benefits, unemployment compensation, retirement, child support or alimony payments, letter with balance on Electronic Benefit Transfer (EBT) card, or reference letter If income is paid in cash, please provide a letter from employer to include the current date, date hired, employee’s name and address, employer’s name/address/phone number, wages per hour and how many hours of work per week, and frequency of pay period. The letter must be signed and dated by the employee and employer.

3. Household member information, including names, social security number, and date of birth

4. Insurance card(s), including Medicaid and Medicare, if applicable

Sliding fee scale is calculated based on family size and income:

2019_Sliding_Fee_Scale.pdf

Federal Poverty Guidelines 2019

Read the Guidelines

Forms

Patient Registration Form

Patient Registration Form Patient Registration Form Spanish

Other Forms

Past Medical Surgical History Health History Questionnaire Long Copy Privacy Notice Summary Notice