How to Become a Patient

Before you come in, save time by filling out and bringing these forms to your appointment.
We encourage you to come to your appointment fifteen minutes early so we may review the contents of your forms.
New Patient Registration Forms in English
Form to Transfer Medical Records for MiCare Patients

Recomendamos que usted complete estas formas antes de su cita. Esto le ahorrará tiempo.
De igual forma, le pedimos que llegue 15 minutos antes a su cita, para que podamos revisar que sus formas estén completas.
Formas de Registro Para Nuevos Pacientes en Español

If you do not have health insurance
You must apply for a Care Card  and go through the eligibility screening in order to receive discounted services.

1. Patients must complete a Care Card application
2. Call our front desk at 970-668-4040 to make your appointment with the Eligibility Coordinator.
3. Come to your eligibility appointment with all the required paperwork for a pre-screening.
4. Once you have received your Care Card, you can make appointments with our healthcare providers at a discounted rate.

5. Patients are asked to renew their Care Card annually so we can make sure your fee code is assigned accurately based on your income. It is the patients’ responsibility to keep your Care Card current. Patients without a current Care Card will not receive discounted services.

** If you are very ill and have not yet received your Care Card, please call our front desk at 970-668-4040 and let them know your situation. All attempts will be made to work with patients to make sure they get the care they need **

We highly recommend that patients apply for a card and become a member of the clinic before they actually get sick, because the eligibility process can take time.

Please contact our eligibility coordinator directly at 970-668-6681 if you have questions about required documentation.

Care Card Application

Aplicación para la Tarjeta de Descuento

Self-employment worksheet

970-668-6681 / 970-668-4040
info@summitclinic.org

If you have Medicaid,  CHP+ or Medicare
When you call to make an appointment, please mention that you have Medicaid. You will also need to bring your card with you to your appointment.

If you have Private Insurance
We are in network with United Health Care, Rocky Mountain Health Plans, Aetna Cofinity, Anthem Blue Cross Blue Shield and Cigna. If you have these insurances, you will need to pay your copay at time of service, and we will submit a claim to your insurance company for the care you receive.

If you have a different insurance carrier, we are sorry that we do not directly bill your insurance. If you would like to receive services at Care Clinic, you will need to pay out-of-network prices.

Dental Insurance
We are not in-network with any dental insurance companies. If you have Dental Insurance and would like to receive services at Care Clinic, you will need to pay full fee for your services and then submit your own claim to get reimbursed for your dental care. If you have dental insurance, we encourage you to seek care at one of the many private dental offices in our community. If you have barriers to accessing care, please contact us – we would love to help you navigate our local resources.