Dear PHC Patient,

Welcome to Partnership Health Center! We look forward to your upcoming comprehensive dental exam. You will find our dental clinic on the second floor in Suite B.

Please click here for Adult Dental Registration Forms. Please click here for Pediatric Dental Registration Forms.

Completing this paperwork ahead of time is encouraged but not required.

You can access additional patient and release of information forms here on our website.

Please arrive 30 minutes early for registration and bring the following items:

1. Driver’s license or photo ID
2. Insurance card(s)
3. Proof of income to apply for the Sliding Fee Scale (see back for more detail). We encourage you to apply even if you have insurance. The Sliding Fee Scale can help you with the cost of your deductible and may also make non-covered services more affordable.
4. Current medication bottles or a list of your medications and their dosage.
5. It is important for your dentist to obtain copies of your relevant dental records and x-rays. Contact your previous dental provider and request that they be e-mailed to dental@phc.missoula.mt.us or stop by and ask a receptionist for assistance.
6. We will ask you for a flat fee when you check in. If you have Medicaid or private insurance, this flat fee does not apply.
   
   

If you need to cancel or re-schedule we require at least 24 hours’ notice. Failure to give adequate notice may result in delays re-scheduling your visit. Call 258-4185 for a receptionist.

Need Directions?
From I-90: Take the North Orange Street Exit 104. Follow Orange Street under the underpass. Once through the underpass, take the first right onto Alder Street. Turn right on Owen Street. PHC is on your right at the next corner!

From downtown: Head north on North Orange Street. Turn left on Spruce Street. Turn right on Owen Street. PHC is on your right at the next corner!

Our goal is to provide you with dental care that fits your budget. To determine your eligibility for our sliding fee scale, we must collect information on how much income your household earns each year.
In order to avoid delays in getting your services discounted we ask that you present your proof of income as a part of your registration for your appointment.

For each working member of you household, bring in one of the following:

• 1040 tax form for the most recent filing year – Preferred documentation
• One month of recent, consecutive pay stubs – For all employment if working multiple jobs
• Social Security benefit letter – Or most recent bank statement showing monthly SSDI deposits
• Bank statement – For fixed income
• CHIMES report or SNAP Benefit Award Letter – Food stamp benefit history
• Pension or retirement award letter
• Grant letter – Students only
• WIC Benefits (screenshot from WIC Shopper app or last WIC benefit letter)

What is the definition of a household?
A household includes all individuals who live together and are related by birth, marriage, or adoption. It also includes all individuals who may or may not live together, but share a taxed household.

Example 1: A family of 4 (2 parents and 2 children) would be a household size of 4. We would need proof of income for both parents if they are both employed.

Example 2: A group of five college students live together and share rental expenses. We would consider each student a household size of 1. We would require proof of income on an individual basis.

Are you interested in purchasing insurance?
PHC has Certified Application Counselors that can answer your questions and help you with your Medicaid or Marketplace applications. Call (406) 258-4450 for more information or to make an appointment.

If you have questions or would like additional information about our sliding fee scale, call (406) 258-4450.

Thank you for choosing PHC for your primary care. ​We look forward to meeting you!