Who Is Eligible For Services?

Eligibility is determined by providing your Proof of Indian documentation, demonstrating linkage to a Federally Recognized Indian Tribe. Proof of Indian documentation verifies if the registry meets one of the following eligibility categories; is an enrolled consortium member, an enrolled California Indian, an enrolled out of State Indian, or a California descendant.

​

How do I Register?

​

1. New patients must submit a Patient Registration Packet and copies of all required documentation.

2. A complete Patient Registration Packet must be received prior to scheduling your first appointment.

3. Once all required documents are received, they will be reviewed for determination of eligibility. This process normally takes two to three business days but can be expedited in case of a true medical emergency.

4. As soon as eligibility is determined, the applicant will be notified by phone or email if an email address was provided.

5. Patient Registration Packets are available on this website and at all IHC locations. Please call us if you would like to receive a Patient Registration Packet by mail.

6. Additional consent forms and authorizations may be required onsite.

Patient Forms

Patient Registration Forms

• Adult Registration Packet

• Minor Registration Packet

• Non-Indian Registration Packet

• Notice of Privacy Practices

• Notice of Privacy Practices Acknowledgment Form

• Consent for Treatment and Assignment of Benefits 

• Patient Rights and Responsibilities

• Advance Directive Information

• Advance Directive Acknowledgement Form

Patient Information Forms

• IHC Notice of Privacy Practice

• Dental Materials Fact Sheet

Please Bring to Register

• Proof of Indian (BIA Letter, Tribal ID Card or Tribal Letter)

• Proof of Residency (Current utility bill, DMV Registration, or rental/lease agreement)

• Insurance card(s)

• Copy of Social Security Card

• Marriage Certificate (If Non-Indian Spouse)

• Birth Certificate (If Child/Minor)

• Proof of Income (If Uninsured)

Advance Directive Forms

• California Advance Directive Healthcare Kit