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Example Service Information and Instructions

Please note: you will speak with a health care professional at your appointment about your medical information, all of your options, and you will be able to ask questions.

Information regarding your visit:

Applicable to the following patients: 

  • Requirements here

Instructions for your visit:

  • Instructions here. Some Examples provided below
  • You must have a guest with you for this appointment to drive you home. The guest must remain at the clinic for the entire visit.

  • Do not use any illegal drugs or alcohol for 24 hours prior to your visit.
  • Do not use marijuana for 2 hours prior to your visit.
  • Do not wear any jewelry.
  • Your index finger must be free of dark nail polish, gel polish, or artificial nails.
  • Do not eat, drink, or chew anything 8 hours before your visit. This includes no food or gum. You may drink water or clear Gatorade up to 2 hours before your visit.
  • In order to keep staff and patients safe during the COVID-19 pandemic, PPIL requires masks for everyone coming into the health center, even if the person has been vaccinated.

  • You must have a photo ID to enter the building. If you have questions or concerns about bringing an ID, please give us a call.

  • If you are late to the appointment we do reserve the right to reschedule. Give yourself plenty of time to get here.
  • To cancel or reschedule your appointment, please call us or cancel your appointment via the website at least 24 hours in advance.


It is important to follow these instructions to make sure you are able to be seen for your appointment.



  • Payment Information should go here

Do you have Medicaid?

  • Additional information here

Do you have insurance you’d like to use for your visit?

  • Insurance information here. Example language: We recommend contacting your insurance company directly to confirm your eligibility and benefits. Please make sure to bring proof of insurance to your appointment. If you have not yet provided your insurance information please call us with your card available.

Good Faith Estimate

  • Information on the estimate for price

Financial Assistance

  • Information on any financial assistance