Sliding Scale Eligibility Application

Slide Fee FAQs

What is a sliding fee scale?

A sliding scale fee is a discount that helps make healthcare more affordable. It’s based on your income and how many people live in your household.

Do I have to be uninsured to qualify?

No! You can apply even if you have insurance—especially if you have high out-of-pocket costs or limited coverage.

How do I apply?

First, we need some basic information to create an account for you in our patient medical record system. This is completed during the scheduling process, so once your appointment is scheduled, simply fill out a short application on our website under Patient Resources>Sliding Scale Eligibility Application and provide proof of income. Our staff can help you through the process.

What documents do I need to provide?

Please bring one or more of the following:

• Recent pay stubs (last 2–4 weeks)
• Most recent tax return
• Social Security or unemployment income letter
• SNAP/food stamp verification or other options listed on the application

Is my information kept private?

Absolutely. Your personal and financial information is protected and kept confidential, per HIPAA regulations.

Will I need to re-apply?

You must reapply once every 12 months, or sooner if your income or family size changes.

What services are covered under the sliding scale?

• Medical visits
• Behavioral health
• Dental care
• Not Covered: Dental labs, materials and supplies prepared off-site
• Ask us what’s covered—we’re happy to help!