All new LRMC medical patients must complete this form packet in its entirety. Please download the new patient packet and bring the completed forms to your next appointment.
All new LRMC dental patients must complete this form packet in its entirety. Please download the new patient packet and bring the completed forms to your next appointment.
Our sliding fee program is intended to make our services affordable and assure that no patient is denied care due to the lack of insurance or finances. Eligibility for the program is determined by a patient’s family size and income. An application must be completed annually and proof of income is required.
Each year patients are required to provide updated contact and insurance information.
A signed release form must be obtained from a patient before their protected health information can be shared with other individuals or organizations. This is the form that is completed by new patients so that we can request records from your previous medical provider; and it is the form used so that we can forward your medical records should you ever leave the area.
LRMC is proud to be a National Health Services Corps site. We promise to serve all patients, offer discounted fees to patients who qualify, not deny services based on a person’s race, color, sex, national origin, disability, religion, sexual orientation or ability to pay.
This health center is a Health Center Program grantee under 42 USC 254(b), a deemed Public Health Service employer under 42 USC 233(g)-(n), and an FTCA deemed facility.
© Copyright 2023 Little River Medical Center. All Rights Reserved.
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