For your first visit to Swope Health, please arrive 30 minutes before your appointment, and bring your:

  • Insurance card (for any active insurance plans you are enrolled in)
  • Photo ID
  • Medication bottles for any drugs you are currently taking
  • Immunization records (for minors)

Consent

When you register, you will also give consent for your care and make arrangements to pay for your services. Our providers may not treat you without your consent or the consent of a legal guardian, when applicable.

Important Information on Payments, Discounts and Identification Documents

Swope Health recognizes paying for healthcare can be a challenge, especially if you do not have insurance. For that reason, we participate in a number of grant programs that could potentially help you pay for the care you receive at our clinics. If you’re interested in being considered for such a program, there are certain documents (see list below) we need from you to see if you qualify for assistance. Please bring them to your first appointment.

Acceptable Proof of Income Documents:

  • Current Paycheck stub.
  • A letter on company letterhead. Please include the following information: hourly rate, gross pay and the pay period.

If your employer does not have company letterhead, we will accept a notarized letter from your Employer.

Please include the following information: hourly rate, gross pay and the pay period.

  • Current Unemployment Determination Letter.
  • Social Security, pension, trust, SSI Disability award letter, food stamp budget summary or child support check.
  • Current financial aid, Pell Grants, scholarship papers.
  • Current tax information.
  • Bank statements showing consistent payroll deposits.
  • W2 Forms (adjusted gross income).
  • For elderly parents living with adult children or adult grandchildren, include income if adult children or adult grandchildren claim parents as dependents on their tax return.  Otherwise, parents should be considered as independent for the purposes of income and so do not count their adult children’s income.
  • Non-cash items such as food stamps are not included in the income

Acceptable Proof of Address Documents:

  • Current utility (electric, gas or telephone) bills.
  • A current piece of mail addressed to you (within 30 days).
  • Current driver’s license (as long as the address matches what is on the registration packet.)
  • Current paycheck stub with your current mailing address located on the check stub.
  • Any government information that was mailed to you (Social Security, pension, trust, SSI Disability Award letter, food stamp summary or child support check.)
  • Lease or mortgage agreement.
  • Photo or printed electronic copy of bills, bank statements or paycheck stubs.

If you do not wish to be considered for these programs, that is perfectly fine. We will still need you to provide one of the following Acceptable Forms of Documentation for Identification

  • Driver’s License (Includes Expired)
  • Matricula Consular/ Consular Identification Card  http://www.migrationpolicy.org/article/consular-id-cards-mexico-and-beyond
  • Passport (Includes Expired)
  • School/College Identification Card
  • Guardianship Documentation
  • Social Security Card
  • Birth Certificate
  • An Individual Taxpayer Identification Number (ITIN)- This is a tax processing number issued by the Internal Revenue Service. It is a nine-digit number that always begins with the number 9 and has a range of 70-88 in the fourth and fifth digit. Effective April 12, 2011, the range was extended to include 900-70-0000 through 999-88-9999, 900-90-0000 through 999-92-9999 and 900-94-0000 through 999-99-9999. IRS issues ITINs to individuals who are required to have a U.S. taxpayer identification number but who do not have, and are not eligible to obtain a Social Security Number (SSN) from the Social Security Administration (SSA).

While payment is expected at the time of service, all patients coming to Swope Health will be seen, regardless of their ability to pay. Review more information about this and other important patient rights and responsibilities by downloading the appropriate registration packet below.

New Patient Registration