SLIDING FEE SCALE DISCOUNT PROGRAM FAQs
Sliding Fees are offered to everyone with household incomes below 200% of the Federal Poverty Level. A Nominal Visit Fee is offered to patients whose household income is below 100% of the Federal Poverty Level.
The best and most accurate way to determine what your individual sliding scale fees would be is to call the office and schedule an Intake Appointment. At an Intake Appointment, you will meet with an Intake Coordinator to calculate your discount and take care of new patient paperwork.
You will need to bring basic income information for each person living in your household. You will also need a picture ID for each adult who wants to be a patient.
For everyone that lives in your household, please bring the following:
- Last year’s Federal Tax return, including all attachments (not just the W-2)
- Last 2-3 paycheck stubs
- Unemployment benefits statement
- Statement of Social Security benefits
- Statement of all pension benefits
- Current Food Stamps benefit letter or statement from the Food Stamp office
- Statement from the Clerk’s office of child support received or paid
- Statement of any other form of income coming into your household
- If you are a full time student, bring a copy of your current schedule
- Picture ID of each adult wanting to become a patient
If you have any questions, please call or stop by the office before your intake appointment so we may assist in making sure you have all the appropriate information required.
If there are items on the list that you do not have, it is okay – still come to the Intake Appointment and talk about your individual situation with your Intake Coordinator.
