Forms and Information

Visit Costs
You will be charged a co-payment at the time of service, according to your insurance eligibility. We also offer patients assistance with payment plans.

MAP Patients: $10 co-pay for medical and counseling services
Uninsured Patients: can vary depending on sliding fee scale eligibility for medical services, $0 for counseling services.

Preparing for Your Visit
Please be prepared with the following information for your medical visit:

• Insurance changes
• Change in address or phone number(s)
• Your most current identification card
• A list of your current prescription medications
• Health concerns that you want to discuss with your provider