PATIENT RESOURCES

Everything you need
before and after your visit

Registration forms, health videos and help paying for care, all in one place.

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Patient Forms Rights and Privacy Patient Education Sliding Fee Scale

Before Your Visit

We update patient information every year. Please bring:

  • Photo ID
  • Insurance card, if any
  • Current prescription bottles

Questions about forms?(208) 356-4900

Patient Forms

Complete your registration online before your visit. The form guides you through any required fields, prompts you for your photo ID and insurance card, and is sent securely to the clinic. No printing needed.

Medical

For new and current medical patients.

New Medical Patient Registration PacketAuthorization for Treatment of Minor Child

Dental

For new and current dental patients.

New Dental Patient Registration PacketAuthorization for Treatment of Minor Child

Behavioral Health

For counseling patients, including school-based therapy.

For adult registration forms, call (208) 356-4900.

School-Based Health Centers Packet

EnglishEspañol

Your Rights and Privacy

Good Faith Estimate

You have the right to an estimate of what your care will cost before your visit, so you can plan your finances.

EnglishEspañol

HIPAA Notice and Authorization

Your privacy is very important to us. If you have a concern or question, contact us right away.

Notice of Privacy Practices (English)Notice of Privacy Practices (Español)HIPAA Authorization (English)HIPAA Authorization (Español)

A digital version is available through DocuSign. Call (208) 356-4900 to request it.

Medical Records Release

For Grand Peaks to request your medical records from another provider, complete and sign this release.

Return it to any Grand Peaks location, fax it to the number on the form, or email it:

EnglishEspañol

A digital version is available through DocuSign. Call (208) 356-4900 to request it.

Patient Education

Short videos from our providers.

Sliding Fee Scale

Care You Can Afford

As a Federally Qualified Health Center, Grand Peaks offers a Sliding Fee Program based on income and family size, using federal poverty guidelines. It’s available to those who qualify, with or without insurance.

  1. New patients: fill out the Sliding Fee application in your New Patient Registration Packet.
  2. Bring proof of income within 3 days of your appointment, or full fees apply.
  3. Established patients: bring proof of income to your next appointment.

Sliding Fee Discount Application

Download, print and bring it with you.

English (PDF)Español (PDF)

A digital version is available through DocuSign. Call (208) 356-4900 to request it.

Proof of Income Options

Medicaid patients: complete the application. No proof of income is needed.
Medicare patients: proof of income is needed.

Bring proof of gross income for everyone in your household. Any one of these works:

  • 2 most recent pay stubs for each working household member
  • Last year’s tax documents
  • Social Security or disability income statements
  • No verifiable income: a signed, dated letter from someone close to you (not a family member), with their phone number
  • New job: a letter from your employer, or our Income Verification form

For after-hours assistance please call (208) 356-4900 and you will be assisted by our after-hours answering service. For emergencies, please call 911.

Upper Valley Community Health Services, Inc. DBA Grand Peaks Medical, Dental, Behavioral Health and Pharmacy is a 501(c)3 nonprofit organization. Grand Peaks complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Anti-discrimination Notice. Call (208) 356-4900.

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