Central Care CHC_EN - Central Care Integrated Health Services

Welcome To
Central Care Community Health Center
What To Bring To Your Appointment
www.Centralcarechc.org
Please bring the following along with your completed
patient packet:
The following will be needed for all household members (if
applicable):
•
Martin Luther King Site
8610 Martin Luther King
Houston, Texas 77033
713-734-0199
Photo Identification
(Driver’s License, School, Military, Identification
Card, etc.)
•
Proof of Insurance (Insurance Card); if applicable
•
Current medications
Three (3) Proof of Income for all household members
dated within the last 60 days; required for all
uninsured patients that wish to utilize our sliding fee
discount for charges applied to the deductible or noncovered charges.
•
•
Household members include spouse, common-law
spouse, live-in boyfriend/girlfriend
Proof of income may include check stubs dated within
the last 60 days, letter from employer on letterhead,
social security award letter, most current tax return
(required if you are a business owner) child support,
unemployment, and/or a letter of support accompanied
with a copy of the supporter’s ID and contact
information.
Third Ward Site
3315 Delano
Houston, Texas 77004
713-831-9663
Acres Home Site
1102 Pinemont
Houston, Texas 77018
281-822-0900
South Main Site
14085 South Main
Houston, Texas 77035
832-954-7647
CCCHC Dental Center
3315 Delano
Houston, Texas 77004
713-831-9655
Name: _________________________________
Appointment Date: __________________________
Time: ______________________________________