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.

 

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.

 

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

 

Patient Intake Forms


Form Category

View, Download, or Print

Intake Forms (English)

(Required)

Intake Form

Consent Form

Financial Agreement

Patient Rights

Intake Forms (Espanol)

(Required)

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

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."

 

G.R.E.A.T. Experience

Tell Us About Your
G.R.E.A.T. Experience


HealthLinc is striving to make your healthcare experience GREAT. We would like to hear about your GREAT experience and the HealthLinc staff member who made it possible.
Coverage Options

Healthy Indiana Plan (HIP 2.0)

HIP 2.0 has been approved! The state of Indiana is now accepting applications online for the new Healthy Indiana Plan (HIP 2.0).

 

Health Insurance Marketplace

Starting Nov 1, 2015, you will be able to enroll in a health insurance plan that covers essential benefits, pre-existing conditions, and preventive services. The next open enrollment period is:

Nov 1, 2015 to
Jan 31, 2016

 

 

 

 

 

 

 

 



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).