How to Enroll As a New Patient with Clinica
Enrollment screening is a process of determining which payment program you and your family qualify for or how much you should pay on Clinica’s sliding-fee scale.
Because your financial situation can change, we require patients to update their financial assistance eligibility every year.
Documents Needed to Apply for Financial Assistance
Bring all necessary documents to your appointment. We will not be able to help determine what financial assistance you qualify for if you do not bring the necessary documents. If you cannot bring one or more of the documents, please cancel your appointment and reschedule once you have all the documentation.
- Picture ID for all adult applicants.
- Social Security numbers for all family members (if applicable).
- Legal Permanent Resident Card if resident of U.S., or work permit (if applicable).
- Proof of address under patient’s name such as public service bills or other bills. Statement date should be for previous or current month.
- Insurance cards, for example: Medicaid, Medicare or private health insurance, etc.
- Proof of unearned income, for example: child support, SSDI, SSI, or unemployment letter.
- If self-employed, bring previous month business ledger. The ledger needs to reflect total earning for the month and total business expenses for the same month.
- If pregnant, need to know expected delivery date. Bring picture ID or birth Certificate and Social Security card (if applicable).
- Children under age 18: Passport, birth certificates, Colorado ID or school ID (if applicable).
- If paid with check stubs, all check stubs from previous month. If you are paid with cash please provide a signed and dated letter from your employer. Letter needs to state the hours worked per week, pay per hour, pay frequency and gross income from the last month. Make sure your employer listed his/her phone number and business address.
- If shared residency: Bring a signed, dated letter from the person you live with. The letter should include the person’s name, address and, phone number. You will also need to bring a bill dated the previous or current month from the person writing the letter.