School Form Information

School Forms

School Based Clinic Registration

Formulario de Registro

Registration Form

School Based Clinic Consent

Formalario de Consentimiento

Consent to Treat

Registration PDF Version

Authorization for Release of Information

Payment Policy

We are staffed by an extremely hard-working group of employees whose goal is to help our patients be able to access services as easily as possible. Like other medical providers, we expect payment for the services we provide. We do offer a Sliding Fee Scale for patients who qualify.

Payments

  • Payment is due at the time of service.
  • Co-pays cannot be waived.
  • We accept cash, checks, bank cards, money orders, MasterCard, Visa, and Discover.

Insurance

  • We will submit claims to most major insurance carriers including Medicare and Virginia Medicaid.
  • Please bring your insurance card with you to every visit so that we can ensure that our records are accurate.
  • If your insurance requires a referral or prior-authorization for you to be seen at Tri-Area Community Health, it is your responsibility to obtain prior to your visit. If not obtained, you will be responsible for the charges.

Specific questions regarding insurance coverage should be addressed by your carrier, or our business office may be able to assist you.