Sliding Fee Discount

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 family 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:

• Proof of information regarding family  size and identity information for all individuals contributing to family income.

• Proof of 30 days gross income for every member of the family contributing to income. Specifically, all types of earned and unearned income.

• Examples of proof of income include:

  • 1040 Federal Tax Form

  • pay stubs/wages and tips/gratuities/bonuses

  • back pay

  • military pay

  • self-employment, hobby income, compensation for personal services

  • income from IRA distributions, interest or annuities, dividends, capital gains, pension, rent

  • royalties and foreign income, alimony

  • Last two unemployment check stubs 

• If you have no income, provide a letter of support or reference from an organization/individual and a signed statement of zero income. 

• Additional documents may be required on a case-by-case basis.