29/08/2015
For those of you who can not make the town hall meeting tomorrow, here is the information to sign up your family members for service at the clinic. Payment can be made via PayPal from the clinic website at www.fhcliberia.com. Just click on the link tab and it'd take you to the Paypal link.
MEDICAL SERVICES MEMBERSHIP APPLICATION FORM
DEAR
FAMILY HEALTH CENTER (FHC) IS PLEASE TO PROVIDE YOU AND/OR YOUR FAMILY WITH A MEDICAL SERVICES MEMBERSHIP FOR THE PROVISION OF MEDICAL CARE AT OUR FACILITY LOCATED AT 42 SD COOPER ROAD IN PAYNESVILLE, MONROVIA, LIBERIA. FAMILY MEMBERSHIP CONSISTS OF TWO ADULTS AND TWO CHILDREN UP TO 18 YEARS OF AGE.
MEMBERSHIP ENTITIES YOU TO THE FOLLOWING:
-24 HOURS/7 DAYS A WEEK ACCESS TO PROVIDER
-PRIORITY ACCESS FOR SCHEDULING OF APPOINTMENTS, SAME DAY
WALK-INS AVAILABLE
-ACCESS TO (UPCOMING) AMBULANCE SERVICE 24 HOURS A DAY
-50% OFF CONSULTATION, LABORATORY AND XRAYS FEES
-25% OFF ALL PRESCRIBED MEDICATION FILLED AT THE ONSITE
PHARMACY AT EACH VISIT
-REFERRAL ACCESS TO A RENOWN HOSPITAL IN ACCRA, GHANA WITH ADVANCE CONSULTATION WITH HOSPITAL PRIOR TO TRAVELING OUT OF
LIBERIA
-TIMELY FEEDBACK TO FAMILY MEMBERS REGARDING CARE WITHIN
HIPPA GUIDELINES
-US TRAINED MEDICAL DOCTOR, CARE IN A WESTERN STYLED FACILITY
MEMBERSHIP FEES PAID IN ADVANCE HAVE THE FOLLOWING DISCOUNT:
- 6 MONTHS PAID IN FULL IN ADVANCE, RECEIVE ONE MONTH FREE
-12 MONTHS PAID IN FULL IN ADVANCE, RECEIVE TWO MONTHS FREE
*$15.00 EXTRA PER MONTH PER EACH ADDITIONAL PERSON
*MINIMUM THREE MONTHS MEMBERSHIP PREPAYMENT IS REQUIRED
Family Health Center 42 SD Cooper Road Paynesville, Monrovia Liberia, West Africa.
www.fhcliberia.com admin@fhcliberia.com +231(0)880349658 or +231(0)880661100
MEMBERSHIP TYPE- SELECT ONE:
INDIVIDUAL ( ) INDIVIDUAL PLUS ( ) FAMILY ( ) FAMILY PLUS ( )
LENGTH OF MEMBERSHIP- SELECT ONE. MEMBERSHIP STARTS SEPTEMBER 1,15
THREE MONTHS ( ) SIX MONTHS ( ) TWELVE MONTHS ( )
PLEASE PROVIDE NAME, AND NUMBER OF FAMILY MEMBER(S)
1.___________________________________________________________________________
2.___________________________________________________________________________
3.___________________________________________________________________________
4.___________________________________________________________________________
5.___________________________________________________________________________
6.___________________________________________________________________________