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You must be a registered patient of Alliance Community Health Center in order to receive services. You may not be approved for the Sliding Fee Program until your application is complete.

Checklist for Insured Patients

For all first-time visits of the year please bring the following:

  • Identification (photo Id is required and can be any of the following)
    • Valid Photo Driver’s License
    • Valid Passport
    • Employee Photo or Student ID
    • Public Assistance Identification Card
    • Alien Registration Card (Green Card)
  • For children, Please bring the following:
    • Birth Certificate for all members of the family
    • Immunizations
    • Valid Photo ID for Parent and or Legal Guardian
  • Social Security Card
  • Proof of Insurance/ Insurance Card
  • Copayment (depending on insurance)
  • Proof of Residence
    • Cable or Phone Bill
    • Utility Bill ( gas, electric, or water bill addressed to you one month prior to date of service)
    • Current received mail (postdated) etc.
    • Lease forms or letter from person you live with stating the length of time at present address and their utility bill.
  • Proof of Household Income (If married you must provide spouse income proof
    • Most current tax returns or W-2, All 1099’s
    • Last two payroll check stub (gross income)
    • Social security earnings (or other retirement or VA benefits), including unemployment and child support, court orders, welfare checks, workman’s compensation checks, etc
    • Letter from Employer/parent/caregiver if a patient does not file income tax returns and does not get paid with a check.
    • Bank statement showing earnings deposited for one month.

Checklist for Un Insured Patients

  • $25 Minimum Balance for Medical Visits / Dental Visits vary
  • Identification (photo Id is required and can be any of the following)
    • Valid Photo Driver’s License
    • Valid Passport
    • Employee Photo or Student ID
    • Public Assistance Identification Card
    • Alien Registration Card (Green Card)
  • For children, Please bring the following:
    • Birth Certificate for all members of the family
    • Immunizations
    • Valid Photo ID for Parent and or Legal Guardian
  • Social Security Card
  • Proof of Household Income (If married you must provide spouse income proof)
    • Most current tax returns or W-2, All 1099’s
    • Last two payroll check stub (gross income),
    • Social security earnings (or other retirement or VA benefits), including unemployment and child support, court orders, welfare checks, workman’s compensation checks, etc.
    • Letter from Employer/parent/caregiver if a patient does not file income tax returns and does not get paid with a check,
    • Bank statement showing earnings deposited for one month.
  • Proof of Residence
    • Cable or Phone Bill
    • Utility Bill ( gas, electric, or water bill addressed to you one month prior to date of service)
    • Current received mail (postdated) etc
    • Lease forms or letter from person you live with stating the length of time at present address and their utility bill.