Become a Patient

 

HealthLinc wants to be a medical home for you and your family. Becoming a HealthLinc patient means that your experience will include:

 

A Team of Healthcare Providers

We have a team of physicians, nurse practitioners, and dentists that can best address your needs. We also have a group of nurses, hygenists, medical assistants, behavioral health consultants, and support staff that are focused on your care.

 

Integrated Care

We treat every part of your body. HealthLinc can provide or help you get access to medical, dental, and behavioral health services to call upon for all of your healthcare needs.

 

Accessibility

We’ll do our best to provide you with timely and affordable care. We have evening and Saturday hours at most locations and treatment options for individuals with or without insurance.
For Normal Business and After Hours, call 1-888-580-1060.

 

Coordinated & Reliable Care

HealthLinc staff will work with you to arrange how to share your healthcare information with other local medical providers outside of the HealthLinc system to make certain your care is well coordinated and what we know about you is up to date.

 

Call us at 1-888-580-1060 to get started! We’ll help you:

  • Arrange for a new patient intake appointment
  • With new patient paperwork (see “Patient Intake Forms” section below)

 

Financial assistance options for uninsured and underinsured families and individuals

To determine your eligibility for support programs and sliding fee scales, we will need some information from you when you come for your intake appointment. Please bring the following information. If any information is missing, your intake appointment will be rescheduled. If you have questions, please call your local HealthLinc clinic and ask to speak with the Intake Coordinator.

  • Birth certificate or passport
  • Photo identification (driver’s license, state ID, school ID)
  • Social security number
  • Medicaid, Medicare or commercial insurance card (if applicable.) If a child has been denied Medicaid, bring the denial letter
  • Proof of current resident (e.g. utility bill, bank statement, phone bill)
  • Last year’s federal tax return (1040 form) or waiver of filing (From 4508-T)
  • Paycheck stubs for most recent 30 days (if employed.) If you (or someone in your household) works but do not have pay stubs, provide a signed letter from your employer on the employer’s letterhead (with contact name and phone number) and the amount you are paid.
  • Proof of any other sources of income: unemployment, Social Security, pension/401(k)/annuities, worker’s compensation, disability, self employment profit or loss, etc
  • If you have no income, please bring a “food and shelter” letter from the person with whom you are living (this is a letter signed by that person stating that they are providing you with food and shelter). This letter must be dated, provide the address, and be signed by the person with whom you are living.

 

This health center will not deny services  solely based on the inability to pay.  You may be eligible for a sliding fee  discount.  See a HealthLinc Intake Coordinator for more information.

 

For information on feedback from our current patients, please click here.

 

Patient Intake Forms


Form Category

View, Download, or Print

Intake Forms (English)

(Required for Appointment)

Intake Form
Consent Form
Financial Agreement
Patient Rights
Intake Forms (Espanol)

(Required for Appointment)

Intake Form
Consent Form
Financial Agreement
Patient Rights
Privacy Practices (English)

(Information Only)

Notice of Privacy Practices
Privacy Practices (Espanol)

(Information Only)

Notice of Privacy Practices
Privacy Practices Psychiatry Addendum (English)

(Information Only)

Notice of Privacy Practices
(Psychiatry Addendum)
Privacy Practices Psychiatry Addendum (Espanol)

(Information Only)

Notice of Privacy Practices
(Psychiatry Addendum)
Clinic Information Sheets (English)

(Information Only)

East Chicago
Knox
Michigan City
Mishawaka
Porter-Starke
South Bend
Valparaiso
Clinic Information Sheets (Espanol)

(Information Only)

East Chicago
Knox
Michigan City
Mishawaka
Porter-Starke
South Bend
Valparaiso


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Patient-Centered Medical Home

Patient-Centered Medical Home (PCMH) is a team-based health care delivery model led by a physician or other health care professional that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults."

 

Healthcare Advice
For Normal and After-hours healthcare advice, call (888) 580-1060.
This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.
Coverage Options
For enrollment assistance into the Healthy Indiana Plan or Health Insurance Marketplace, please contact one of our enrollment specialists at (888) 580-1060.

 

 

 

 



HealthLinc, Inc. is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).