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.

I have insurance? 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. We often combine insurance benefits with slide fee discount to reduce your total out of pocket expense.

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 or via a phone call with one of our Financial Counselors. To apply, 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 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!