trust us for life
Caring for the Growing Needs of Our Community.
New Patient Health Questionnaire
Sliding Fee Scale Application
In order to become eligible for the WHN ’s Sliding Fee Discount Program, you must first complete a Sliding Fee Scale Application. To speed up the approval process, you may print off the attached application and drop off at one of our five Health Centers. For your security, please do not submit SFS documents through the website. Fill out and return to office. Call your health center to schedule an appointment with a Navigator to complete any of these forms.
Notice of Privacy Practices
WHN’s Notice of Privacy Practices describes how your Protected Health Information (PHI) may be used and/or disclosed by WHN in the course of providing care to you.
Hoosier Healthwise (Medicaid) Application
In order for you to become eligible for Hoosier Healthwise, you must first complete an application. To speed up the approval process, you may print off the attached application and drop off or mail to either Health Center.
Healthy Indiana Plan (HIP) Application
The Healthy Indiana Plan (HIP) will provide state-funded health insurance for uninsured Hoosier adults between 18-64 whose household income is between 22%-200% of the Federal Poverty Level.
Request a Call Back
Pellen tesque in ipsum id orci porta dapibus curabitur non nulla sit amet nisl tempus convallis quis ac lectus.