Prepare for a Clinic Visit

The following documents are available for review, printing and completion prior to your clinic visit.  You may bring these completed forms with you to your appointment.

• Full Registration Form (for new and/or existing patients)
• Quick Registration Form (for existing patients)
• Medicare Questionnaire (for Medicare patients only)
• Privacy/HIPAA Notice (View Privacy Notice)

What to bring with you to your appointment:

• Picture ID
• All Insurance Information
• Required Referral letter
• Any required co-payments/deposits (LSUHSC Shreveport accepts Visa and MasterCard)
• Current proof of income (for patients requesting free care classification)
• LSU Patient ID card

Items to note before your appointment:

• You must be registered for each clinic visit or before having a test.
• Please allow for time to park; parking is available at identified parking lots (see map).
• Clinic registration is done by appointment time. To decrease your overall waiting time, we recommend that you do not arrive more than 30 minutes prior to your appointment.
• Please leave your valuables at home.  Please bring as little as possible to your appointment to minimize the security risk.

Payment of Services:

• If you are uninsured and do not qualify for free care, you may be required to pay a self-pay deposit prior to treatment for this visit.
• If you are uninsured and unable to provide valid proof of Louisiana residency at the time of registration, you may be required to pay a minimum $250.00 non-Louisiana resident fee at each clinic visit.
• If your insurance plan does not list LSUHSC Shreveport as an in-network provider, you may be responsible for up to 100% of the hospital and physician bills.

If you require additional information, please contact the clinic at 318.813.2625.