Patient Registration and Admissions

Welcome to the Leo Pocha Memorial Clinic.  For questions about registration and services at the Helena Indian Alliance,
please call 406-442-9244.

Access to services at the Leo Pocha Memorial Clinic is not limited to Native American clients.  For non-native clients, contact our business office to explore third party arrangements such as the ACA or Medicaid.

New Patient Registration (Form link down below)

  • Completely fill out and sign a new patient registration, health history, HIPAA, and authorized release of health information if necessary.
  • If applicable, make a copy of the following:
    • Photo ID
    • Tribal ID
    • Social Security Card
    • Birth Certificate
    • Health Insurance Card
    • Medicaid and Medicare Card
  • If you do not have health insurance and are Non-Native
    • Please fill out the sliding fee scale worksheet and a co-payment will be determined and required at the time of visit.
    • Also, schedule a free appointment with Julie to help apply for health benefits.
  • Turn in all registration materials to the Clinic Receptionist.
  • The Clinic Receptionist will call you when your paperwork has been processed and entered into the Medical Information System (2-5 business days)

Thank you for your cooperation and we look forward to serving you!

New Patient Registration Form