Request Medical Records
Please select, complete and print the authorization form needed to release or obtain records.
Patients with Insurance
If a patient has insurance, their carrier will be billed according to services provided. Applicable co-pays and deductibles will apply. Benefits will be verified, so please remember to bring your insurance card to all appointments. Patients are responsible for verifying provider network status with carrier prior to appointment.
Patients without Insurance or limited benefits
If you are uninsured or have limited insurance benefits, you may provide documentation to establish eligibility for discounted fees for services, also know as a sliding fee scale. Eligibility is based on household size and income. To view a printable list (available in English and Spanish) of the items you will need to bring with you to your eligibility appointment click here.
Fees for Services
Services at MEHOP are not free. Payment, including co-pays and deductibles, will be expected at time of service.