We’re so glad you’re here! The information below will help you prepare for your upcoming visit with us and ensure a smooth visit on the day of your exam.

Patient Registration Forms

Save time and delays on the day of your appointment by pre-registering with us. Make sure to bring diagnostic films or other test results that may have been ordered or performed by another physician as well.

See All Forms

Medical Emergencies

If you’re experiencing a life-threatening medical emergency, call emergency medical services at 911 immediately. Inform the emergency room staff that you are a patient of Mainline Health and they will contact us.


If one of our doctors suggests a specialist evaluation or diagnostic testing that requires a referral, please allow up to three business days for processing. Rest assured, we’ll make every effort to provide this for you as soon as possible.

Prescription Requests

If you need a prescription refill, please contact the pharmacy at your primary Mainline Health location. We ask that you plan ahead to avoid any interruptions to your medication.

Financial Assistance

At Mainline Health Systems, we provide care for everyone, regardless of insurance status and coverage.

We currently accept Medicare, Medicaid, and most major insurance plans. If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, you may need to pay at the time of your visit.

For your convenience, we accept all forms of payment:

  • Cash
  • Checks
  • Visa
  • MasterCard
  • Discover
  • American Express

Outreach Contacts:

Mainline Health has outreach staff available to help patients navigate the insurance marketplace.

  • For Eudora, Warren, & Wilmot, call Devonte at 870-663-4112
  • For Rison, Sheridan, & Star City, call Sheila at 479-957-9725
  • For Dermott, Monticello, & Portland call Kailyn at 501-621-5683

Sliding Fee Payment Scale

If you're unable to cover the cost of care through insurance, we'll work with you on a payment plan based on a sliding fee scale. Contact your local Mainline for questions.

For patients without insurance, we offer a sliding fee scale based on income and family size to ensure that quality, compassionate health care is readily accessible to everyone.

Sliding Fee Eligibility Form

We Proudly Accept ARKids First

At Mainline Health Systems, we believe every child should have access to healthcare services. That’s why we proudly accept ARKids First health insurance, provided by the Arkansas Department of Human Services.

ARKids First health insurance provides two coverage options for Arkansas children under the age of 19 who otherwise might go without.

Learn More about ARKids First

Have A Billing Question?

Contact us today. Our billing specialists are standing by to help.

(870) 538-5414, ext. 3

Corporate ADDRESS

583 West Gaines

Monticello, AR 71655


Phone: (870) 538-5414

After Hours: (870) 538-3355