New Patient Registration
Thank you for your interest in becoming a patient at MarillacHealth. Below is the New Patient Registration Form to print and drop off or mail in. To apply for a sliding scale discount you must provide information in the Financial Assistance Packet. You can download the form in Spanish or English using the links below, or pick one up at one of the MarillacHealth locations in Grand Junction (6th Street Clinic: 2333 N. 6th Street near St. Mary’s Hospital, 12th Street Clinic: 2139 N. 12th Street in the 12th Street Plaza, or at the 29.5 Road Clinic: 510 29 1/2 Road at Mesa County Public Health) or in Montrose (87 Merchante Drive near the Nissan Dealerhip).
Medical Forms
Dental Forms
If You Dont Have Health Insurance
If you do not have health insurance, you may qualify for one of our discount programs that will allow you to access health care at discounted rates. You will be asked to meet with one of our Eligibility Specialists to determine if you and/or your family qualify for the programs based on family size and income.
One of our Eligibility Specialists can explain the details of applying for our sliding fee programs. You must provide proof of income to apply for the programs and bring your picture ID.
You might also be interested in reviewing options to purchase insurance on the Connect For Health Colorado Insurance Marketplace. You can schedule an appointment with a Certified Guide at either MarillacHealth or Hilltop Health Access (our partner) by clicking here.
