What do I bring to my appointment?

Driver's License or Gov't ID

Insurance Card
All of your medication bottles or medication list
Immunization Records

Co-Pay (credit, debit, cash or check)

Primary Care Office

 

 

 
Patient Application


Authorization for Verbal Disclosure of Information

Authorization for Release of Health Information

Authorization for Access to Patient Info Through Health Info Exchange

School-Based Locations


Students must attend Donovan Middle School, MLK Elementary or Kernan Elementary School to be eligiable to receive services at the School-Based Health Center.

Parents must complete an enrollment packet below to register their child.

Enrollment Packet


For more information about our School-Based Health Centers, view our brochure below. 
School-Based Health Center Brochure 


Sliding Fee Program 

The Sliding Fee Discount Program allows patients who have no health insurance or are under-insured to receive heal the care services at a lower cost . To be part of the program you must provide proof of income for your household. Your income has to be less than the current federal poverty level. The poverty level will depend on the number of people who live in the home and the amount of money they make all together. The discount for the "Sliding Fee Discount Program" varies but those who qualify and need the most help often can get significant discounts or services.

There are several simple steps required to apply for the program.
-Complete the application by clicking
here. 
-Provide copies of income for all eligible people living in your household (i.e. unemployment stubs, pay checks, etc.)
-Click
here for the Sliding Fee Program brochure to learn more. 


Services covered under the Sliding Fee Program include:

-Family Medicine

-Routine preventative exams

-Well child care and immunizations

-Diabetic Care

-Physical exams
-Gynecological care

-Podiatry


You will need to apply for this program every year. Your discount will last 12 months. You will need to complete the same application and provide proof of income. 

At your Primary Care visit, you will be required to complete the following forms. All forms are available right here to fill out prior to your appointment.

Click the links below for access to each form. 

upstatefamilyhealthcenter.org   |   315-624-9470

Follow Us
  • Facebook Social Icon
  • Instagram Social Icon

© 2017 by Upstate Family Health Center Proudly created with Wix.com