A Full Service Medical Center for Your Health Care Maintenance & Acute Care Needs

To Establish Care:

To Transfer Records:

  • Please complete the following form to transfer records in / out of our clinic. 
  • If you are requesting we send your records to a new provider, there is no charge. If you are requesting the records for other reasons, charges may apply. Please call our office for details.
    Release of Medical Information Form

To Apply for Sliding Scale:

  • Please submit completed form with appropriate paperwork for review of eligibility at least 48 business hours PRIOR to your appointment date.  Sliding scale determination is based on the NHSC guidelines and requires income verification.   Verification will typically include last year's tax return and the previous month's pay stubs for all wage earners in the household. 
    Sliding Scale Application
  • Sliding scale discount prices apply only if you pay in full at the time of service.
  • Eligibility will be re-evaluated on a semi-annual basis.
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