• New Patient Screening

    Wellness Center
  •  -
  • ALL NEW PATIENTS SHOULD BRING THE FOLLOWING DOCUMENTATION TO THE INTIAL VISIT:

    Two forms of identification to include: 

    • Picture ID
    • Proof of residence ( Valid documentation includes: utility bill, lease, voter card w/ name and current address)

    ONE of the items listed below:

    • If employed – last three pay stubs, last tax return or w2 form
    • If not employed- notarized letter with name / address of person providing food/shelter
    • Other income: Unemployment Compensation, Disability or SSI letter

    Insurance Documentation: 

    • Private insurance card/Medicaid Card/Medicare Card
    • If you are uninsured, just let us know
  • No Income and Address Verification Documentation

    In the event you do not have valid forms of documentation according to the lists above, please have the "No Income and Address Verification Letter" completed and notarized. 

    Click here to download the "No Income and Address Verification Letter"

  • Questions

  • Upload Documentation

  • In order to assist with patient screening and enrollment, please upload the following documentation if available. All uploads are secure and confidential. 

    • Patient ID
    • Proof of residency
    • Income Verification documentation
    • Insurance Card
    • Other documents 
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