In the CommunityRural Health
Sliding Fee Discount Application for 2024
Sliding Fee Program
WE ARE COMMITTED TO QUALITY CARE REGARDLESS OF ABILITY TO PAY.
If you do not have medical or dental insurance or if your insurance does not cover certain services, you may be eligible to enroll in our Sliding Fee Program. Fees are discounted based on household size and income. You will be asked to provide proof of household income, usually the 1040 tax form from the most recent year, a copy of your W-2s, Social Security or pension statements, pay stubs, and any other income received by your household prior to obtaining services. If you do not qualify for the Sliding Fee Program, you will be billed for the full amount.
All patients on the Sliding Fee Program are required to pay a minimum fee at the time of each visit. Click the link below to download the Sliding Fee paperwork.
