School Form Information
School Forms
School Based Clinic Registration
Formulario de Registro
School Based Clinic Consent
Formalario de Consentimiento
Registration PDF Version
- Download and Print
- Printable Form Ver/Descargar/Imprimir
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.
