Patient Registration

Patient Registration and Financial Screening

The primary patient population served by Daily Planet Health Services is people experiencing homelessness or housing instability. As of July 1, 2025, our health center also welcomes all individuals from the broader community who may be facing barriers to care, including individuals living in or around public housing and/or individuals living with HIV.

Registration Process

When you arrive at Daily Planet Health Services as a first time patient you will be asked to fill out a Patient Registration/Financial Screening form. The cost for services is determined during the financial screening process. A sliding fee scale is used for those who qualify. If you would prefer to complete this paperwork beforehand you may access the form below to print, fill out, and bring with you to your visit to Daily Planet.

English Forms:

New Patients – Medical and Dental
New Patients – Behavioral Health
New Patients – Pediatrics (ages 18 and under)
Existing Patients – Renewal – Medical and Dental
Existing Patients – Renewal – Behavioral Health

Spanish Forms:

Registration is available from 8am-11:30am and 1pm-3pm Monday through Friday.

You may also register over the phone or pre-register online. There is no set time for phone registration. If a staff member is not available to complete a registration at the time of your call, they will take your information and call you back when available.

What to Bring With You to Register

Photo identification (if available)
Insurance card
Proof of income (pay stubs) or statement of no income (example: Notice of Action Food Stamps)
Your most recent tax return, W-2, or a social services determination letter
Homeless agency referral, if applicable

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.

Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.

You can ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule a 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 www.cms.gov/nosurprises.

More information about payments and discounts can be found here.

Patient Rights and Privacy Practices

If you would like to review our privacy practices, click here for English and here for Spanish.

If you would like to review the patient rights and responsibilities, click here for English and here for Spanish.

Nondiscrimination and Accessibility Notice

Further Preparing for Your Visit

The Agency for Healthcare Research and Quality offers a Question Builder tool to help patients get the most out of their medical appointments. Utilizing this tool will help you plan exactly what questions to ask during your visit! The Question Builder tool is available by clicking here.