WHAT TO EXPECT AT YOUR APPOINTMENT
Getting the Most Out of Your Appointments
Following the below recommendations will make your first appointments run more smoothly and help us provide you with the best possible service.
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(Uninsured Patients)
- If you need to reschedule, please call us more than 24 hours before your appointment.
- If the appointment is for a child under 18 years, please bring all vaccination records. The child does not need to be present for the financial screening appointment.
- Please bring a completed financial screening form.
- If you are unable to complete the financial screening form in advance, please arrive 25 minutes early for your appointment.
- Along with the completed financial screening form, please bring the following items with you:
- Your photo ID
- Proof of household income for last two months such as:
- Consecutive pay stubs (8 stubs for weekly pay/4 stubs for every other week pay)
- Most recent signed 1040 tax return
- Letter from employer on letterhead stating hours worked per week and rate and frequency of pay
- Social Services or Social Security Administration Agency letter on letterhead (such as notice of unemployment, disability or retirement benefits)
- Notarized support letter from individual providing financial assistance
- Most recent Food Stamp award letter (not EBT card)
- For a complete list with full detail, please refer to the financial application form. Additional forms you may need are available on the Forms page.
Please arrive 15 minutes early for your appointment.- If you need to reschedule, please call us more than 24 hours before your appointment.
- Your insurance card (if applicable) and a photo ID.
- Medication registration form (if you are a Medicaid patient): print and download here or complete online here.
- A list of any questions you have about your health. Put the questions most important to you at the top of the list.
- All of your medications in their original containers, including prescription, over the counter, natural, and herbal medications and dietary supplements.
- A list of other healthcare providers you have visited. Write down their contact information and the reason for your visit with them.
Cancellation and No-show policies
If you need to cancel or reschedule, please call more than 24 hours before your appointment. If we are not open when you call, you can leave a message on our appointment cancellation voicemail. Any appointment canceled or rescheduled with less than 24 hours notice is considered a broken appointment.
Dental Cancellation and No-Show Policy
If you need to cancel or reschedule your appointment, please call more than 24 hours before your appointment.
Any dental appointment canceled or rescheduled with less than 24 hours notice is considered a broken appointment. Patients are allowed one (1) broken appointment in a six-month period. If a patient has three (3) broken appointments in a twelve-month period, they cannot schedule future dental appointments but may call to schedule a “same day” appointment if one is available.
RECOMMENDED CONTRIBUTIONS FOR UNINSURED PATIENT SERVICES
| Service | Amount |
| Medications | $5 for 30 day supply |
| $10 for 90 day supply | |
| Medical Visit | $20 |
| Same Day Visit | $25 |
| Nurse; Labs | $15 |
| Vision | $20 |
| Bill Counseling; Medicaid Enrollment; VCU Behavioral Health; Some Contraception | No contribution required |
DENTAL CONTRIBUTIONS FOR SERVICES
For Medicaid Patients: If you receive dental services not covered by your Medicaid plan, you will be asked to make a contribution toward the cost of the service.
| Service | Amount |
| Dental Level I – Diagnostic and Hygiene | $30-40 |
| Dental Level II – Extractions Routine or Surgical | $60-$80 |
| Dental Level III – Restorative/ Fillings | $60 |
RECOMMENDED CONTRIBUTIONS FOR UNINSURED PATIENT SERVICES
| Service | Amount |
| Medications | $5 for 30 day supply |
| $10 for 90 day supply | |
| Medical Visit | $20 |
| Same Day Visit | $25 |
| Nurse; Labs | $15 |
| Vision | $20 |
| Bill Counseling; Medicaid Enrollment; VCU Behavioral Health; Some Contraception | No contribution required |
DENTAL CONTRIBUTIONS
FOR SERVICES
For Medicaid Patients: If you receive dental services not covered by your Medicaid plan, you will be asked to make a contribution toward the cost of the service.
| Service | Amount |
| Dental Level I – Diagnostic and Hygiene | $30-40 |
| Dental Level II – Extractions Routine or Surgical | $60-$80 |
| Dental Level III – Restorative/ Fillings | $60 |