PATIENT INFORMATION

Appointment Information

Advanced appointments at Community Health Center of Fort Dodge, Mason City, Dayton, and Eagle Grove are preferred. However, for urgent needs, efforts will be made for the patient to see a provider the day of your call.

Individuals under the age of 18 must be accompanied by a parent or legal guardian.

Please contact your local CHC if you are unable to make your scheduled appointment. Please review Community Health Center’s no-show policy Here.

What to bring on your first visit:
For your first visit at Community Health Center, you will be asked to answer a few new patient questions. These questions include patients ethnicity, race, emergency contact, veterans status, employment status, sexual orientation, and gender identity.

To qualify for our sliding fee program, uninsured or privately insured patients are also asked to bring proof of their household income. Our in house financial advocate will be here to assist you with this process and answer any questions you may have regarding this program.

Please be prepared to provide the following information:

• Name
• Date of Birth
• Insurance Card
• Phone Number
• Proof of Income
• Photo Identification
• Description of Medical or Dental Concern

Payment Options

• Medicaid
• Medicare
• Title 19
• Hawk-I
• Most Private Insurance
• Affordable Care Act Health Plans
• Amerigroup
• Iowa Total Care
• Molina
• MCNA
• Delta Dental
• Dental Wellness Plan
• Discount Fee Schedule

We accept cash, check, debit, and most major credit cards as well as Apple Pay.

You should bring your ID and insurance card with you to each appointment. If you are a minor or dependent on an insurance card you will need the name and date of birth of the insurance subscriber as well.

Sliding Fee Program

Patients without insurance may be eligible for a discount based on household size and income. You must apply for the discount. The Sliding Fee Program allows us to reduce or “slide” the fees for the care you or your family receive at Community Health Center of Fort Doge with locations in Fort Dodge, Mason City, Eagle Grove, and Dayton. Any patient can apply for the Siding Fee Program to help pay for their care. If you have insurance, you may still qualify. To make an appointment, or for more information. Please call one of our Financial Advocates.

The following is the information you should bring with you when you come to your first appointment to see if you qualify for the sliding fee discount:

• Proof of household annual income, such as copies of…
  • Pay Stubs (last 30 days)
  • Income Tax Form (current year)
  • W2s
  • Award Letters (SSI, SSDI)
  • Dividend/Interest Statement
  • Statement From Individual Providing Support
  • Copy Of Current Benefit Check