Good Faith Estimate Questionnaire

Which of these applies to you?*

My insurance will help pay the cost of this careI am on the OCH sliding scaleI am uninsured or my insurance will not help with this care

Please contact your insurance company to ask what you will have to pay for your care.

The cost for patients on the sliding scale is between $0 and $35. If you are receiving family planning or root canal services, please contact the clinic directly for an estimate at 541-386-6380.

You can learn more HERE

What kind of care are you getting from One Community Health?*

What kind of medical care are you getting?*

A Well Child check, sports physical, or immunizationI am receiving another kind of care

What kind of dental care are you getting?*

A dental exam or cleaningA procedure (such as fillings or root canal)

We are currently offering these services to our patients at no charge!