Sliding fee application forms

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About the sliding fee discount program

if you need help paying for health care expenses, we offer discounted fees based on your household size and income. For more information and to apply, meet with one of our eligibility specialists. Find a clinic near you to make an appointment.

If you qualify for our sliding fee discount program, the fees start at:

  • $20 for a medical appointment
  • $45 for a dental appointment

You will not be denied services if you are unable to pay. 


For your appointment with an eligibility specialist, please bring:

  • Documentation of one month (30 days) of total income for your household. Bring one of the following:
    • Pay stubs from the past 30 days showing gross income (total income before taxes or deductions) for everyone in your household
    • Award or benefit letter (if receiving income from any other taxable income besides wages, e.g.: interest payments, self-employment, unemployment, etc.)
    • Employer letter stating your gross income
    • Last two unemployment check stubs (if receiving unemployment)
    • A letter of support or reference from an organization or individual
  • A copy of the most recent year's 1040 tax returns (if you filed taxes)
  • Birth and marriage certificates for your dependents (if you did not file taxes)
  • Additional documents may be required on a case-by-case basis.

Uninsured patients

We welcome uninsured patients. We ask all uninsured patients to make an appointment with one of our eligibility specialists to learn if they qualify for health insurance through Washington Healthplanfinder, our sliding fee discount program, or other programs. You may be eligible for low-cost or no-cost insurance. One of our eligibility specialists can help you understand your health insurance options. Learn more about insurance assistance. To make an appointment with an eligibility specialist, find a clinic


If you choose not to apply for insurance or the sliding fee discount, we ask for a deposit to cover the initial cost of your care.

  • $80 for medical
  • $90 for dental

You will not be denied services if you are unable to pay. 

Insured patients

We accept most insurance, including Washington Apple Health (Medicaid), Medicare, and private plans. Proof of insurance or payment is expected at the time of service, including co-pays.