Patient
Information
Are you a new patient?
Download and fill out the new patient forms below:
Find a Provider
We have an amazing team of providers who are ready to give you and your family the best comprehensive, preventative health and dental care available.
Are you a current patient?
MyChart allows you to easily access medical records and patient information, view test and lab results, refill prescriptions, schedule appointments and communicate with your doctor in a convenient, online portal.
Additional Services
La Esperanza Clinic provides additional services to established patients, which includes:
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Case Management Services
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Telehealth Services
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Prescription Discount Program
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24/7 Online Patient Portal
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After Hours Nurse Line
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Se Habla Español
Affordable Ways to Pay
La Esperanza Clinic offers several payment methods which allow patients to have access to the care they need at a cost they can afford.
Sliding fee discount is available based on family size and income, regardless of insurance status. Proof of income is required from all members in the patient's household in order for a patient to be eligible for the Sliding Fee Scale Discount Program.
Prescription Discount Program
La Esperanza Clinic Patients can receive prescription discounts at the following locations:
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Genoa
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Myers Drug
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H-E-B (original location)
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Medical Arts Pharmacy
For more information, please give us a call at (325) 658-5339.
Proof of Earned Income
If patient gets paid, bring most recent pay stubs
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One month of most recent pay stubs
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If no pay stubs, provide Employment Verification Form
If patient does not have stubs or copies of checks, the patient can have their employer fill out an Employment Verification Form. For all patients, a filed tax return will be accepted until June 30 of the current year.
Proof of Unearned Income
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Current year Social Security Award Letter for Supplemental Income
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Unemployment Benefits for current year Disability Award Letter
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Pell Grants
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Child Support (current printout from the Attorney General's office)
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Retirement check for current year or statement showing payments
Proof of No Income
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Bring a letter of support (with the dollar amount provided in a month) and a copy of the picture ID of the supporter if they will not be present at the appointment
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Patients staying at a shelter should provide a letter of Support on a Business Letterhead
Note: If visit is not covered or paid in full, any remaining balances will be billed to patient.
Good Faith Estimate
Under federal law, health care providers must give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
You have the right to receive a “Good Faith Estimate” for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
You can use the tools above or contact us for a Good Faith Estimate before you schedule an item or service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit https://www.cms.gov/nosurprises or call 214-633-4036.
Insurance
If using WEBTPA or an HMO insurance plan (ex. BCBS HMO), a referral will be needed PRIOR to your visit. If a referral cannot or has not been obtained, your appointment will be canceled or rescheduled.
The following options are available if a referral cannot be obtained:
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Pay the minimum payment required of $91 for an existing payment. As a courtesy, we will file your insurance. Any remaining credit will be refunded to you
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Pay the minimum payment required of $146 for a new patient. As a courtesy, we will file your insurance. Any remaining credit will be refunded to you
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Call your insurance provider and change your PCP to the La Esperanza Clinic provider you will be seeing. (Please request for PCP change to be effective immediately)
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Apply for our Slide Discount Program to check if you qualify for a reduced price. (proof of income is required)
If you have any further questions, please ask our Front Desk Staff at your visit or call us at (325) 658-5339.