Save time by completing these patient information packs before your visit with Kintegra!
We are dedicated to providing quality health care, health education and preventive care services to all members of the community regardless of financial barriers (ability to pay) through the regular publication of a sliding fee scale. Discounts described on the sliding scale reflect the eligible patient’s obligation based on family household income in relation to the Federal Poverty Guidelines, published annually. Kintegra annually revises and re-issues the sliding scale to reflect changes in the Federal Poverty Guidelines. Our sliding scale fee application forms are provided below.
For your Medical and/or Behavioral Health Visit
SPANISH
Adult Patient Information Pack (Spanish) 2020
Pediatric Patient Information Pack (Spanish)
Sliding Scale Fee Application (Spanish) 2020
ENGLISH
Adult Patient Information Pack (English) 2020
Pediatric Patient Information Pack (English) 2020
Sliding Scale Fee Application (English) 2020
Revocation of Consent to Release Patient Information 2020
For your Dental Visit:
SPANISH
Adult Patient Information Pack (Spanish) 2020
Pediatric Patient Information Pack (Spanish) 2020
Sliding Scale Fee Application (Spanish) 2020
ENGLISH
Adult Patient Information Pack (English) 2020