Annual Renewals for CHDC Patients

Healthcare Discount Renewals - IMPORTANT NOTICE

Patients who received a Healthcare Discount for 2025, must RE-APPLY for 2026. Patients who receive a healthcare discount are required to renew at the beginning of each year or they won't get the discount at their next appointment. Those who qualify can receive medical, dental, and prescription medication at a lower cost, based on their family size and income. Patients with or without insurance are able to apply for a healthcare discount.

Step 1: Complete the Healthcare Discount Application. Applications are available at any Patient Services desk or by calling our Healthcare Discount Coordinator at 610-326-9460 ext. 559.

Step 2: Submit completed Healthcare Discount Application along with one of the following:

  • A copy of the most recent tax return you are listed on or
  • Two current pay stubs or
  • Social Security, Disability or Pension benefit letter (or last two bank statements if direct deposited).

If you do not have any documented income, you will need to complete the Self-Declaration of Income & Housing Form and include with your Healthcare Discount Application.

Step 3: Submit all requested forms PRIOR TO YOUR APPOINTMENT in one of the following ways:

  • Email to: hcdp@ch-dc.org
  • Drop off at Patient Services Desk
  • Mail to: CHDC, 351 W. Schuylkill Drive, Suite G-15A, Pottstown, PA 19465 Attn: HCDP Coordinator

Consent to Treat

HIPAA Privacy Notice and Communications Preference Forms are required to be updated yearly or when there is a change of information

Dental Health History

Dental Health History form required to be updated every two years.