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

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Contact

Phone: (504) 524-1210

Fax: (504) 524-1491

Address

Corporate:

1515 Poydras St # 1070, New Orleans, LA 70112, USA

©2018 BY EXCELTH, INCORPORATED