Registration

To reduce waiting time, please complete and print the patient registration form.

If you are a new patient, please arrive 15 minutes early.

Don’t forget to bring these documents:

  • Photo Identification
  • Insurance card(s), including Medicaid and Medicare
  • All current medications
  • Immunization records
  • Proof of income and address
  • Copayment or sliding fee costs
  • Hospital admission paperwork for emergency room visits within the last 30 days

deltahealth becoming patient medical treatmentPayment

DHC accepts most private insurances, Medicaid, Medicare MSCAN, CHIP, and others.

Payment is expected at the time of service.  Cash, personal checks, money orders, and credit cards are acceptable forms of payment.

Sliding Fee Discount

If you do not have insurance and/or have low income, you may qualify for sliding fee discounts.  Eligibility for discounts is determined using the Department of Health and Human Services’ Poverty Guidelines.

Proof of income must be shown by:

  • Current pay stubs
  • Tax forms W-2 or 1099
  • Most recent profit and loss statements, if self-employed
  • Letter from your employer
  • Documents showing income from unemployment, social security disability or death benefits, alimony, child support, public assistance, pension, adoption assistance, divorce decree, separation agreement, or other court filed agreement with amount and length of agreement.

For patients with none of the above, most recent filed federal tax return or transcript of tax return from the IRS may be submitted.