Info for Patients

New Patients

The East Jordan, Bellaire, and Central Lake Family Health Centers are proud to be the medical home to over 10,000 people. All of our medical providers are Board Certified professionals dedicated to keeping you healthy with the latest knowledge and technology. You can be assured of receiving excellent medical care at any of our locations. We look forward to taking care of the healthcare needs of you and your family!

The following forms may be downloaded and printed for you to complete and bring with you to your first appointment. Please plan on arriving 15 minutes early for your appointment to facilitate the registration process.

New Patient Registration Form

Adult New Patient Medical History

Pediatric New Patient Medical History

Billing/Patient Accounts

The Health Center bills all insurances on your behalf for services you receive and we participate with many commercial insurance carriers including Blue Cross Blue Shield of Michigan, Blue Care Network, Cofinity and Tricare, as well as plans such as Medicare, the Michigan MI Child Program, Northern Health Plan, CareSource, and other Medicaid qualified health plans. You are responsible for any amounts that are not covered by your insurance including deductible and co-pay amounts. Please make sure that we receive a current copy of your insurance card at each appointment so that the billing can be processed accurately. Your insurance company is the expert about your policy, and you should contact them directly to answer your questions about the services they cover for you and what your cost share amounts are.

Our patient accounts representatives can be contacted Monday through Friday, from 8 am to 5 pm by calling (231) 536-2206, Extension 149.

Sliding Fee Discount Program

We believe that everyone has the right to affordable health care. The Health Center has developed a Sliding Fee Discount Program for patients and their families based on income and family size. This program may provide you with a substantial discount on the following services: On-site office visits, on-site procedures, on-site X-ray services and assistance with prescription costs.

Our Patient Resource Coordinator is available to meet with those uninsured or underinsured to help determine eligibility for health care coverage and prescription assistance programs. We will help you with the application processes for these programs so that you have access to affordable, quality healthcare.

Sliding Fee Application

2020 Sliding Fee Guidelines

For information about our Sliding Fee Discount Program and our Prescription Assistance Programs please contact our Patient Accounts Representative at (231) 536-2206, Extension 149.

Patient Confidentiality and HIPAA Privacy Practices

We are dedicated to keeping your personal health information protected and the Notice of Privacy Practices describes the ways in which your protected information may be used or disclosed. A copy of our patient privacy practices is given to our patients at their first visit and upon request.

Print Notice of Privacy Practices