Patient Portal & Forms
Punctuality: Please remember to be on time. If you are unable to make your appointment, please contact us at least 24 hours in advance so we can reschedule your appointment.
Financial Policy: Please bring your insurance card with you to your appointment and notify us of any changes in your insurance coverage. All co-pays are due and payable at time of service.
No-Show Policy: Appointments are important to all who need care. Three (3) missed appointments may result in being discharged from the practice.
Workers’ Compensation: Please provide the date of injury, employer, and Workers’ Comp liability insurance information. Failure to provide this information at the time of your visit makes you responsible for payment on the date of service.
Telephone/Address Information: Please notify our front office staff of any address or telephone changes.
Medical Records and Patient Confidentiality:
It is our responsibility to protect the confidentiality of your medical records at all times. Records may only be released with the written consent of the patient or the patient’s legal guardian. If you would like your records transferred, you must sign a release statement giving us permission to share your records or send information to another office. Please allow 5-10 business days to transfer/copy your medical records.
Referrals to Other Providers:
If your provider has determined that you must be seen by an outside specialist such as a cardiologist or podiatrist, for example, you may require a referral. Depending on your insurance, pre-certification may need to be completed in order for your insurance company to pay for your visit(s) with the specialist.
If you wish to make your own appointment, please remember to contact our office and let us know the name of the provider, your appointment date and time. If notes from our office need to be sent, please let us know.
Patients are admitted to Porter Hospital under their hospitalist for acute care. Porter’s on-call pediatrician admits to the nursery and we admit to Helen Porter Nursing Home. Our providers will care for their patients if they are living in a local home or nursing home. Home visits may be scheduled if you are too ill to travel to our office for scheduled care or acute visits.
Fasting Blood Work:
If you are scheduled for fasting blood work, please remember not to eat or drink anything 12 hours prior to your appointment and no alcohol 24 hours prior to your appointment. You may drink water and we encourage you to drink as much water as you like.
In order to ensure quality patient care, Mountain Health Center requires forty-eight (48) hours’ notice to process a medication refill. When you call in for a prescription refill, please have the medication name and dosage as well as the name of the pharmacy you prefer. We will also ask you for your date of birth and a telephone number.
Mountain Health Center’s patient portal promotes better communication with your provider by offering a secure, convenient way to manage your personal health care.
Sliding Fee Discount:
Are you eligible to receive up to a 40% to 90% discount for medical care and 20% – 80% discount on basic dental care?
Mountain Health Center and Red Clover Family Dentistry offer a Sliding Fee Discount Program. Eligibility is purely income dependent and does not require health insurance nor does it matter what company health insurance you have.
Ready to apply? Applications are available in office or click on the link below.
Download our Sliding Fee Discount Program Application
Please call (802) 453-5028, select option 2, then option 4 to find out how you may be eligible for this discount.
Convenient home delivery at no extra charge with potential savings for patients of Mountain Health Center. Download the PDF application here: Pharmacy-Application
Visit the website for more information: www.communityhealthpharmacy.com
For questions on the Community Health Pharmacy applications, contact our Outreach office at (802) 453-5028, select option 2, then option 4.
Please note: To use these forms, please download and fill out.
Download our Patient Registration Form
Download our Universal Consent Form
Download our Notice of Privacy Practices
Download our Mountain Health Center Brochure