Helena Indian Alliance

"Keeping our Community Strong" 

Patient Registration

Patient Registration and Admissions

Welcome to the Leo Pocha Memorial Clinic.  For questions about registration and services at the Helena Indian Alliance,
please call 406-449-5796.

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!