We offer the Sliding Fee Scale to all income-eligible uninsured or underinsured patients, based on annual household income, for most services. Income guidelines and acceptable verification for the Sliding Fee Scale are listed below.
How do I qualify?
To qualify for the Sliding Fee Scale, you MUST show proof of gross annual income for all immediate family members living in your household. Gross income is ALL income from ALL sources before taxes. Applicants should provide a copy of any of the accepted income verification materials listed below.
Acceptable Income Verification
Recent Federal Tax Return
IRS Form W-2 or 1099
Two (2) Current Pay Stubs
How do I get started?
To begin the Sliding Fee Scale application process, simply download the form below, complete it, and take it with you to your next scheduled visit.