[vc_row el_class=”mediczop-set-pd full-width-pd” css=”.vc_custom_1617234442193{margin-top: 5px !important;margin-bottom: 35px !important;border-top-width: 5px !important;border-bottom-width: 15px !important;padding-top: 5px !important;padding-bottom: 5px !important;}”][vc_column width=”1/2″][vc_single_image image=”2433″ img_size=”600×450″][/vc_column][vc_column width=”1/2″][mediczop_title type_title=”v2″ heading=”Prepare For Your Visit” description=”Thank you for choosing DCHC as your new medical home!” css=”.vc_custom_1626984665540{margin-bottom: 20px !important;border-bottom-width: 15px !important;padding-bottom: 10px !important;}”][vc_column_text]
We are excited to have you as a patient and look forward to helping you live your healthiest life. Before your visit you can save time by completing the Patient Registration Forms below.
Please bring the following with you to your appointment:
- Driver’s License or ID Card
- Insurance Card
- If you are uninsured and/or applying for the Sliding Fee Scale, please bring 1 month of most recent household income
We want your experience to be as easy and comfortable as possible. For any questions, contact us at 318.878.6650.
[/vc_column_text][/vc_column][/vc_row][vc_row full_width=”stretch_row” el_class=”mediczop-set-pd full-width-pd” css=”.vc_custom_1626800953015{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 15px !important;background-color: #03b7b1 !important;}”][vc_column][mediczop_title type_title=”v2″ custom_heading=”true” colorpicker_heading=”#ffffff” custom_desc=”true” colorpicker_desc=”#ffffff” heading=”Patient Forms” description=”Below are pre-visit forms to prepare you for your visit.” css=”.vc_custom_1626820958328{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 10px !important;}”][/vc_column][/vc_row][vc_row full_width=”stretch_row” el_class=”mediczop-set-pd” css=”.vc_custom_1626821588767{margin-top: 10px !important;margin-bottom: 25px !important;border-top-width: 10px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 15px !important;}”][vc_column css=”.vc_custom_1626633131634{margin-top: 15px !important;margin-right: 55px !important;border-top-width: 15px !important;border-right-width: 55px !important;padding-top: 15px !important;padding-right: 45px !important;}”][mediczop_title type_title=”v2″ heading=”Uninsured?” css=”.vc_custom_1626821076352{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 10px !important;}”][vc_column_text]If you do not have insurance, or you’re underinsured (your insurance doesn’t cover everything you need it to), DCHC offers a Sliding Fee Discount Program, which provides reduced rates for those who qualify. To apply for the Sliding Fee Application and one of the following Proof of Income Documents to your visit at DCHC. This documentation is a required part of the application process and demonstrates proof of income for all of your income sources.
Accepted documents for Proof of Income:
- Prior year W-2
- Two recent pay stubs
- Letter from employer or Form 4506-T (if W-2 is not filed)
- Self-employed: Three months of income and expenses for the business
- If you do not have any written proof of income, you can submit a self-declaration of income letter.
[/vc_column_text][vc_empty_space height=”16px”][/vc_column][/vc_row][vc_row full_width=”stretch_row” bg_type=”grad” el_class=”mediczop-set-pd full-width-pd” css=”.vc_custom_1627330181790{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 15px !important;background-color: #03b7b1 !important;}” bg_grad=”background: -webkit-gradient(linear, left top, left bottom, color-stop(0%, #E3E3E3), color-stop(0%, #22A9B3), color-stop(54%, #16B3AB));background: -moz-linear-gradient(left,#E3E3E3 0%,#22A9B3 0%,#16B3AB 54%);background: -webkit-linear-gradient(left,#E3E3E3 0%,#22A9B3 0%,#16B3AB 54%);background: -o-linear-gradient(left,#E3E3E3 0%,#22A9B3 0%,#16B3AB 54%);background: -ms-linear-gradient(left,#E3E3E3 0%,#22A9B3 0%,#16B3AB 54%);background: linear-gradient(left,#E3E3E3 0%,#22A9B3 0%,#16B3AB 54%);”][vc_column width=”2/3″ css=”.vc_custom_1627330757986{margin-right: 0px !important;border-right-width: 0px !important;padding-right: 0px !important;}”][vc_row_inner][vc_column_inner][vc_empty_space height=”52px”][mediczop_title type_title=”v2″ custom_heading=”true” colorpicker_heading=”#ffffff” custom_desc=”true” colorpicker_desc=”#ffffff” heading=”Checking In For Your Visit Just Got Easier!” description=”Download our app ‘DCHC Virtual’ to check in for your appointments, complete patient forms & much more- all from your mobile device!” css=”.vc_custom_1627320538278{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 10px !important;}”][/vc_column_inner][/vc_row_inner][/vc_column][vc_column width=”1/3″ css=”.vc_custom_1627330703916{margin-right: 50px !important;margin-left: 0px !important;border-right-width: 50px !important;border-left-width: 0px !important;padding-right: 25px !important;padding-left: 0px !important;}”][vc_single_image image=”3084″ img_size=”300×400″][/vc_column][/vc_row][vc_row el_class=”mediczop-set-pd” css=”.vc_custom_1540905728916{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 15px !important;}”][vc_column][mediczop_title type_title=”v2″ custom_heading=”true” colorpicker_heading=”#000000″ custom_desc=”true” colorpicker_desc=”#000000″ heading=”We Accept The Following Insurances:” css=”.vc_custom_1627408645015{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 10px !important;}”][vc_column_text]Medical
Blue Cross Blue Shield | Cigna | Aetna | Benefit Management | Gilsbar | Humana | Office of Group Benefits | United Healthcare | Vantage Health Plan
Dental
Always Care | Aetna | Delta Dental | Dentemax | Guardian | Cigna | MetLife | Humana | Starmount | Healthy LA Medicaid Dental Plans
Don’t see your insurance listed? Contact us to see if we are in-network with your insurance provider. [/vc_column_text][vc_separator][mediczop_title type_title=”v2″ custom_heading=”true” colorpicker_heading=”#000000″ custom_desc=”true” colorpicker_desc=”#000000″ heading=”Questions?” description=”We’re here to help! Call us at 318-878-6650 or contact us using the form below.” css=”.vc_custom_1627332100011{margin-top: 15px !important;margin-bottom: 15px !important;border-top-width: 15px !important;border-bottom-width: 15px !important;padding-top: 15px !important;padding-bottom: 10px !important;}”][/vc_column][/vc_row]