Southern Dominion Health System, Inc. strives to serve our patients with quality healthcare. Below we have provided documents and information to make it simpler for you and help expedite your care upon arrival at one of our locations.
What to Bring:
- Your ID
- Insurance Card (if applicable)
- Sliding Fee Form (if applicable)
- Aplicación De Tarifa Movil (PDF)
- SDHS, Inc. is a Federally Qualified Health Center (FQHC) which allows us to offer a Sliding Scale Discount to qualifying patients. The Sliding fee discount is based on household income and number of dependents in the household.
Registration:
SDHS utilizes PhreesiaTM patient intake services for patient registration. You will receive electronic forms to your preferred contact method (email, text) to complete prior to your appointment. If you are unable to complete the information prior to your appointment date, please arrive at least 15 minutes prior to your appointment to complete the process in office when you arrive.
- Patient Facts – Information (Word Document)
- Annual Medicare Wellness Visit Health Risk Assessment Form (PDF)
Notice of Privacy Practices:
Click HERE to view this notice describes how information about you may be used and disclosed and how you can get access to this information.
Patient Bill of Rights
The Board of Directors and Staff of Southern Dominion Health System, Inc. (SDHS) respect your rights as a patient and recognize that you are an individual with unique health care needs. We want you to know your rights as a patient as well as your obligations to yourself, other patients, your provider of care and this organization. Please click HERE to read your rights.
Southern Dominion Health System, Inc offers a sliding fee program to its patients. This program offers a discount for medical, dental, and behavioral health services. Income eligibility and family size are required when you apply to determine if you and your family qualify. Ask one of our front desk employees about the sliding fee program and how it can help you.
- Get Sliding Fee Form (PDF)
- Aplicación De Tarifa Movil (PDF)
SDHS, Inc. is a Federally Qualified Health Center (FQHC) which allows us to offer a Sliding Scale Discount to qualifying patients. The Sliding fee discount is based on household income and number of dependents in the household.