Appointment Requests
Text for Appointment
New and existing patients can request an appointment online. After the appointment is scheduled, all forms will be sent to your phone for easy completion.
Items needed to register online or in-person
- Photo Identification (i.e.: Driver’s License or Government Issued Identification – if possible)
- Social Security Card – if possible
- Insurance Card OR
- Proof of Income for last 2 months (i.e.: paystubs, bank statements, Social Security Income, W-2 Statements)
- Federal Income Tax Return (Required for application for medication assistance)
Additional Patient Information
Sliding-Fee Scale Information
The Sliding-Fee Scale is determined by income and Federal Poverty Guidelines. Where a patient falls on the Sliding-Fee Scale will determine their copays. Starting January 1, 2025, the Sliding Fee Scale will change, with increases to most services. Please click the button below to download the complete fee chart.
Download the Sliding Fee Scale Chart
A patient will be informed of their Sliding-Fee Scale status after they have completed the registration process with a BHA Registration Counselor.
Download Form Descarga Formulario
Patient Privacy Notice
Explains the disclosure of medical information.
BHA is committed to protect the confidentiality of medical information about our patients and use that information only to care for them properly. We share this information only in the manner described.
Download Summary Download Form Descarga Formulario
Patient-Centered Medical Home
Describes what a patient-centered medical home is.
Gives the patient an opportunity to understand their role in their health care and their relationship with their provider.
Download Form Descarga Formulario
Authorization for Release of Medical Information
Download the medical record information release forms below.
About Brevard Health Alliance
- Brevard Health Alliance is a Primary Care Medical Home. We provide comprehensive primary care for children, youth, and adults.
- Each patient has an ongoing relationship with a BHA provider trained to provide first-contact, continuous, and comprehensive care.
- BHA providers lead teams of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
- BHA providers are responsible for providing for all of the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals.
- At our facilities, care is facilitated by registries, information technology, health information exchange, and other means to assure patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
- BHA is dedicated to the quality of care and the safety of our patients.
