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Long Island FQHC, Inc. is a nonprofit 501(c)(3) organization (EIN/tax ID number: 27-0216316)

Long Island FQHC, Inc.  © 2010-2015. All Rights Reserved. 380 Nassau Road, Roosevelt NY 11575

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Forms & Insurance Information

To help facilitate your registration process when you arrive,

please click Patient Registration & Patient Consent Form language,

print, and fill out your forms prior to coming in:

Patient Registration:   English  | Spanish

Patient Consent:  Adult English  | Adult Spanish  |

Pediatrics English  | Pediatrics Spanish

Documents Needed For Initial Visit

New Patients, please arrive 30 minutes before your appointment time.

Established Patients, please arrive 15 minutes before your appointment time.

Insurances Accepted: Click here

LIFQHC is affiliated with Nassau University Medical Center. For paying for Care at NUMC.  To see participating plans and participating providers, please click here.

LIFQHC Health Care professionals that do not participate with a health plan will inform the patient or prospective patient, before the non-emergency services, that the amount the health care professional will bill is available upon request; and upon receipt of this request, disclose in writing the amount or estimated amount (fee schedule) that will be billed for services provided or anticipated to be provided absent unforeseen medical circumstances that may arise when services are provide.

If you do not have insurance, you may be eligible for assistance.