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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.  © 2010-2017.

All Rights Reserved. 1600 Stewart Avenue, Westbury NY 11590, Suite 300

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FTCA Deemed Facility


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Patient Portal


 New Patient Information & Forms  




























What to Bring

When you arrive at Long Island Federally Qualified Health Center’s for the first time, we recommend that you bring the following:

If you have insurance:

If you don’t have insurance:


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

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

Forms


For your convenience, you may complete new patient forms in advance. Please select and print from the options below, fill them out completely and bring them with you to your appointment.

New Patient Packet - Registration:  English  |  Spanish


Patient Rights & Responsibilities

The New York State Department of Health requires that patient’s seeking services be informed of their rights. It is part of your patient registration and is an important part of your health care plan.  

Adult - Patient Bill of Rights:     English  |  Spanish  |  Creole

Parent - Patient Bill of Rights:  English  |  Spanish  |  Creole


Privacy Notice

We are committed to maintaining the privacy of your protected health information. Our policies comply with the federal regulations under HIPAA (Health Insurance Portability & Accountability Act).

This Notice describes how your medical information may be used and disclosed and how you can access this information.

Privacy Notice - English | Spanish


How to pay for your Care

Co-payments and deductibles are due at the time of service.  We accept Cash/Credit/Checks

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.
















For Those Without Insurance

If you do not have or cannot afford medical or dental insurance, you may be eligible for reduced rates based on your family’s size and income through our Sliding Fee Scale discount program. You may apply for our sliding fee program in our office during your visit, or you can fill out the form ahead of your visit by downloading and printing the Sliding Fee Scale application form here.

Our Sliding Fee Scale is accessible to all income-eligible insured, uninsured and under-insured patients and is part of our commitment to make sure you get the best care at a manageable cost.

You may also see our sliding scale rates here. Sliding Fee Scales: Click Here