top of page

What To Bring to Our Clinics

These are documents necessary to determine payment based on our sliding fee scale

I. Proof of Income – (Includes all household/family income) – Bring ONE of the following as proof of income.

​

  • 1040 Federal Income Tax Return

  • Social Security Award Letter (SS)

  • Social Security Disability Award Letter (SSDI)

  • Social Security Supplemental Income Award Letter (SSI)

  • Salary/Wages (i.e. Employment Check Stubs)

  • Child Support or Spousal Support

  • Unemployment Letter

  • Interest or Dividends

  • Proof of no income (i.e. food stamp letter)

  • Rental Income

  • TANF

  • Pension/ Retirement

​

II. Proof of Insurance – If Applicable,

​

  • Insurance Card

  • Medicaid Card

  • Medicare Card

​

III. Proof of Identity

​

  • Social Security Card

  • Driver’s License

  • State ID

​

IV. Proof of Residency

​

  • Driver’s License

  • Utility Bill (i.e. Entergy or Water)

​

V. Medical

​

  • Current Medications

  • Paperwork from any hospital visits

 

ALL CO-PAYMENTS ARE DUE AT THE TIME OF SERVICE

Follow

  • googlePlaces
  • facebook
  • Twitter Social Icon
  • Instagram
  • LinkedIn - Black Circle

Contact

Phone: (504) 524-1210

Fax: (504) 524-1491

Address

Corporate:

1515 Poydras St #1070,

New Orleans, LA 70112, USA

2024
Excelth Incorporated ©

EXCELth, Incorporated is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).
This health center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.

bottom of page