Forms & Insurance

All you need to know about billing and coverage

Forms requiring completion

Langley Health Services now offers our New Patient Packets online for your convenience. While we CANNOT accept forms via electronic transmission (fax or email), you may complete these forms online and print them, or download and print them and fill them out. PLease make sure that you bring the completed forms with you when you visit. Depending on the type of services you require (Medical or Dental Services), please make sure you fill out the ENTIRE document packet. (Adobe Reader Required)

  • For the Medical Services document packet, please click here
  • Para el paquete de Servicios Médicos documento en español, por favor haga clic aquí.
  • For the Dental Services document packet, please click here.
  • Para el paquete de documentos Servicios Dentales, por favor haga clic aquí.

 

Health care on site

LHS accepts most major insurances including Tricare, Blue Cross and Blue Shield, United Health Care, Medicare, Medicaid, Medipass, and many others. If you do not have insurance a Sliding Fee Scale discount is available, based on your household income, to those who qualify. If you would like to apply for the Sliding Scale, you must bring in Financial Documentation for everyone in your home or dwelling.

The following list is an example of required Financial Documentation as it pertains to those applying for sliding scale:

  • Most recent Income Tax return
  • Social Security, Disability, and/or VA benefit letter.
  • Retirement/Pension Income documentation.
  • Last four consecutive pay stubs to include Work Comp and/or
  • Unemployment.
  • Food Stamp letter showing the amount of your award.
  • TANF (Temporary Assistance for Needy Families) letter showing the award amount.
  • Court Order for Child Support.

The following financial documentation and/or actions are NOT accepted:

W-2 forms

Mailing applications and/or documentation
Faxing applications and/or documentation
Bank Statements
Social Security 1099

For easy access, please put these LHS numbers in your phone

  • Sumterville 352-793-5900
  • Ocala 352-680-0324
  • 1-888-298-5510

 

Prescriptions

Arrange for prescription renewals and/or a supply of medications to bring.

Contact the Pharmacy (1-888-298-5510) regarding transferring prescriptions. We want to be your pharmacy of choice.

Pharmacy Hours of Operation – Monday through Friday 8:00 A.M. to 5:30 P.M.

Schedule an Appointment

Appointments may be made for routine visits. If you wish to schedule a time for a physical please indicate the date  you would like to be seen.  Once your request is received we will call you and confirm your appointment time.

PLEASE NOTE: If this is an emergency Call 911.

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