Photo Identification (i.e.: Driver’s License or Government Issued Identification, if possible)
Social Security Card – if possible
Insurance Card OR
Proof of Income for last 2 months (i.e.: Paystubs, Bank Statements, Social Security Income, W-2 Statements)
Federal Income Tax Return (Required for application for medication assistance)
Brevard Health Alliance is a Patient Centered Medical Home.
We provide comprehensive primary care for children, youth and adults.
Each patient has an ongoing relationship with a BHA physician trained to provide first contact, continuous and comprehensive care.
BHA physicians lead teams of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
BHA physicians are responsible for providing for all of the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals.
At our facilities, care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
BHA is dedicated to the quality of care and the safety of our patients.
If this is a medical emergency please do not use this form to reach out to us, and instead please call 911.
This form is for general inquires only. It can take up to 72 hours to respond to questions submitted here.