Todos nuestros servicios son 100% gratuitos. Sin embargo, para reservarle una cita, necesitaremos información personal como su nombre completo tal como aparece en su licencia de conducir, su dirección, su fecha de nacimiento, cualquier condición médica subyacente, la información de su seguro, incluidos los ID de miembro, números de grupo, información del seguro de prescripciones, su origen étnico, su raza, su peso, etc. También necesitaremos hacer preguntas médicas. Necesitamos esta información porque los proveedores autorizados requieren esta información para reservar sus citas. Sin la información, no podemos reservar su cita con un proveedor autorizado.

Entendemos que muchas personas no se sentirán cómodas dándonos esta información. Sabemos que todo el mundo tiene un nivel de comodidad diferente en cuanto a compartir su información personal. Por eso, hemos diseñado tres niveles de servicio diferentes. Seleccione, a continuación, qué opción se adapta mejor a sus necesidades y nivel de comodidad.

What kind of Healthcare Provider are you?

What kind of Healthcare Provider are you? Select One Acute care hospitals Ambulatory surgical centers Assisted Living Facilities Behavioral health providers (e.g., substance use disorder, counseling, psychiatric services) Dental services Diagnostic services (e.g., independent imaging, radiology, labs) DME / suppliers (Durable Medical Equipment) Eye and vision services Home and community-based support (e.g., housing services, care navigators, case management) Home health agencies Inpatient behavioral facilities (e.g., inpatient rehabilitation facilities, long-term acute care hospitals, other residential facilities) Multi-specialty practices Nursing homes and skilled nursing facilities Other ancillary services (e.g., chiropractors, speech and language pathologists, physical therapy, occupational therapy) Other inpatient facilities Other outpatient clinics (e.g., urgent care, dialysis center) Other services (e.g., foster care, developmental disability services) Other single-specialty practices Pediatrics practices Pharmacies Primary care practices OTHER

Please specify here

Select one...Acute care hospitalsAmbulatory surgical centersAssisted Living FacilitiesBehavioral health providers (e.g., substance use disorder, counseling, psychiatric services)Dental servicesDiagnostic services (e.g., independent imaging, radiology, labs)DME / suppliers (Durable Medical Equipment)Eye and vision servicesHome and community-based support (e.g., housing services, care navigators, case management)Home health agenciesInpatient behavioral facilities (e.g., inpatient rehabilitation facilities, long-term acute care hospitals, other residential facilities)Multi-specialty practicesNursing homes and skilled nursing facilitiesOther ancillary services (e.g., chiropractors, speech and language pathologists, physical therapy, occupational therapy)Other inpatient facilitiesOther outpatient clinics (e.g., urgent care, dialysis center)Other services (e.g., foster care, developmental disability services)Other single-specialty practicesPediatrics practicesPharmacies (Note: Prescription sales revenue may not be reported as part of revenue from patient care.)Primary care practicesOTHER

How much funding in 2020 did you receive?

How much funding in 2020 did you receive? Select One Under $10,000 $10,000 - $49,999 $50,000 - $99,999 $100,000 - $199,999 $200,000 - $299,999 $300,000-$399,999 $400,000-$499,999 500,000-$750,000 $750,000+

$XX.XX

Total Cost

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