Patient Information

Below are three different sets of forms that are available for you to print, fill out, and then bring in when you come to Rettig Family Health Care for your visit. The New Patient Packet, Medicaid Policy and Patient Consent forms below are to be completed by those who will be new patients at Rettig Family Health Care. Please complete all of the forms and bring them with you for your first office visit.

Please be sure to bring your health insurance card to every visit so that we can make sure we have the most updated and accurate information.


Limestone Medical Center accepts most major insurances, including Medicare, Medicaid, and CHIP. In addition, the Rural Health Clinics offer a sliding fee scale plan to patients based on family size and income. Patients will not be denied service due to an inability to pay. Patients will not be denied services for any reason including: race, color, sex, national origin, disability, religion, age, sexual orientation or gender identity.

At Limestone Medical Center; we offer a program for patients that qualify that discounts the costs of some healthcare services. It is called the Sliding Fee Scale program.

For patients interested in applying for the Sliding Fee Scale program offered to residents of Limestone County, please pick up an application at the Limestone Medical Center’s Outpatient Registration desk, Monday – Friday, between 8:30 a.m. and 5:00 p.m.

Applications may be turned in at the Outpatient Registration Desk, Monday – Friday, between 8:30 a.m. and 5:00 p.m. or in the Emergency Room 24 hours a day/7 days a week.

Applications are processed within a week providing all documents are turned in as requested with the application