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| How
To Become A Patient |
To make an appointment
call 817-625-4254 for the Northside and 817-916-4333 for the Southeast. On the day of your appointment please bring
the following:
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| • Birth dates for all family members |
 |
| • Proof of Income (last 2 pay stubs for
both husband and wife) |
| • Picture ID (a picture id
with your current address) |
| • Complete Insurance Information, if available
(company's name, member of family covered, policy number, and
type coverage] |
• Medicaid or Medicare Card (if
available)
|
• Proof of Address (Utility bill
with current address)
|
• Social Security numbers for both
husband and wife and/or child if patient (if available)
|
• If you do not have insurance,
when you register we will determine what percent of the
actual visit charge you will have to pay. We charge a sliding
scale fee based on your income and family size.
|
Appointments are Encouraged, but Walk-Ins are Welcome !
Download and complete the following form to bring with you:
FORMA DE REGISTRACION DEL PACIENTE
PATIENT INTAKE FORM - ENGLISH
PATIENT HISTORY FORM - EN ESPANOL
PATIENT HISTORY FORM - ENGLISH
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Northside Community Health Center
2106
N. Main Street
Fort Worth, Texas 76164
817-625-4254 |
Southeast Community Health Center
3212 Miller Avenue
Fort Worth, TX 76119
817-916-4333 |
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