To become a patient, please fill out a registration packet in advance of your first appointment. Registration forms can be filled out electronically below. Or, if you'd prefer to use paper forms, please click on "view all forms" to print. Bring completed paper forms to your first appointment. Please come to your first appointment 15 minutes early to give us time to review the forms and to help you fill in any missing information.
In order to qualify for a Care Card to receive discounted services, you need to fill out additional forms and go through a formal screening process. We recommend that you complete this process before you need services because of the additional time necessary to process your information.
1. Call 970-668-4040 and let the staff know you are a new SCCC patient.
2. Next, complete these forms:
c. If you are self-employed, complete this Self Employment Worksheet
3. To be considered for the Care Card and receive discounted services, submit your completed application with your supporting documentation to our Clinic or your local School-Based Health Center Clinic via drop off, mail, or email. The Eligibility Coordinator will evaluate your application and, if eligible, place you on a Sliding Fee Scale and issue your Care Card. Your co-pay based on the Care Card is payable upon check-in for each appointment and any additional fees not covered on the Care Card are due at the end of each visit. If necessary, we will work with you on a payment plan for the settlement of outstanding visit charges.
As a Certified Assistance Application Site, we can also assist you with your Medicaid application. Please submit your completed Medicaid application at the same time of your Care Card application to avoid duplicating supporting documentation.
Prefer to meet in person with our Eligibility Coordinator? Call 970-668-4040 to schedule an appointment. Please arrive 15 minutes early and bring your completed application forms.
If you are very ill and need an appointment but have not gone through this process or received your Care Card, let our front desk know. Every attempt will be made to work with you to make sure you get the care you need.
During the Care Card process, we will review your income and family size and, if you are eligible, place you on the Sliding Fee Scale. Fees are accrued based on the care you receive. We can only provide you estimates of costs.
You will need to pay your entire bill at the end of each visit, but we will work with you on a payment plan as needed.
We are in-network with many carriers. However, you should also check with your insurance to confirm that we are an in-network provider. At the time of service, you will need to pay your copay. We submit your claims to your insurance company for the care you receive.
If your insurance carrier is not in-network, we cannot directly bill your insurance. You will need to pay the out-of-network cost to receive service with us.
We are in-network with many dental insurance plans and you will be charged for services according to your individual plan. If you do not have dental insurance and have a current Care Card, you will be charged according to the Sliding Fee Scale. If you have an insurance plan that we are out of network with, we will courtesy bill your insurance for you. We will also work with you on payment plans.
We accept the following dental insurance:
We are a provider of the Colorado Dental Health Program for Low Income Seniors. This program provides access to dental care to individuals age 60 and over who are not eligible for dental services under any other dental health care program, such as Health First Colorado (Colorado’s Medicaid Program). Our eligibility staff will screen you for eligibility for this program. As funds for this program are limited, eligibility does not guarantee coverage.
If you would like us to send your medical records to a different provider, please complete the health information authorization form and give it to our front desk staff or fax it to 970-668-6699. Please allow 30 business days for processing.
You have the right to review your health records with your provider. Complete this Request for Access form and give it to our front desk or fax it to 970-668-6699. Your provider will review your request and contact you.
You have a right to review your medical records with a provider’s review. If you have concerns, please review the NOTICE OF PRIVACY PRACTICES. You can also review the United States Health Resources and Services Administration (HRSA) policy on the HRSA Privacy Rule.
If you have questions about medical records, please call 970-668-4048.
Aplicación y preguntas frecuentes sobre Medicaid
Hoja de cálculo de trabajador independiente