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Santa Cruz
Women's Health Center
 
   
 

Office Policies


New Patient Forms

Before your first appointment, you can download and complete our registration forms.

Adult Packet for Women
Adult Packet for Men

Child Packet in English
Child Packet en Espaņol

Accessibility

It is our intention to provide needed services to women and children of all races, classes, religions, physical abilities, cultures, ages and sexual orientations. The building is wheelchair accessible. We have bilingual staff on hand to serve our Spanish-speaking clients. Please let us know if you have special accessibility needs and we will try to meet them.

Sliding Scale Rates and Types of Insurance

We charge fees on a sliding scale according to income. CCAH, Medi-Cal, MediCare and major credit cards are welcome. We are able to accept some insurance plans for direct billing. Call our office at (831) 427-3500 for information about fees or billing.

Governmental Programs

We provide low or no-cost services through state funded programs for low-income, uninsured and underinsured residents through the following programs:

Family PACT: birth control, sexually transmitted infection testing and treatment, pregnancy testing, annual exams, and related services.
BCEDP: Breast Cancer Early Detection Program for breast exams and mammograms.
CHDP: Child Health and Disability Program for well child exams and immunizations.
EAPC: Expanded Access to Primary Care for sick visits and preventative health care.
Healthy Families: sick visits and preventive health care for children.

Eligibility for these programs is based on income level and insurance coverage. Call (831) 427-3500 to learn more about whether you are eligible.

Specialized Forms (Only Complete if Requested)

Cancer Detection Forms

Cancer Detection Program Application
Cancer Detection Program Consent
Cancer Detection Program (Spanish) Application
Cancer Detection Program (Spanish) Consent

PACT Forms

Family PACT Application
Family PACT (Spanish) Application

 

 
 

Updated January 27, 2014

 

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Website Designed and Maintained by Denise Lee