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To reduce waiting time, please click the link below to download the registration form. Next, print the form, then fill out all of the information, and bring the printed form with you on your first visit to the nearest Delta Health Center healthcare facility to your location.

Download the printable document(s)
English Version
Spanish Version

Documents Needed

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

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Contact Us
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John Fairman

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CEO

Delta Health Center

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Neuaviska Braugher

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Executive Deputy CEO

About Neuviska
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Dr. Marketta Blue

• • • • • • • •

Chief Medical Officer

Family Medicine

About Marketta
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Myrtis Small
• • • • • • • •
Director of Human Resources & Credentialing
About Jamesha
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L. Don Cole, CPA, CIA

• • • • • • • •

Interim Chief Financial Officer

About Odell
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Robin Boyles

• • • • • • • •

Chief Program Planning & Development Officer

About Robin
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Alyssa Simmons

• • • • • • • •

Associate Deputy CEO, FNP

About Myrtis
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Amanda LACAZE

• • • • • • • •

Chief Of Policy and Strategy

About Tara
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Dr. Inge FORD

• • • • • • • •
• • • • • • • •

DMD Doctor of Medicine in Dentistry

About Myrtis
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Stephanie Goss
• • • • • • • •
Director of Nursing
About Myrtis
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Davis Hayes, Jr.
• • • • • • • •
IT Director
About Temika
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Heather M. Miles

• • • • • • • •

Chief Financial Officer - Revenue Cycle Services

About Margaret
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Cajanique OLLIE

• • • • • • • •

Director Of Registration

About Margaret