Sliding Fee

Sliding Fee Discount Program

This program is designed to provide discounted care to those who have limited means to pay for their office visits. In addition to quality healthcare, patients are entitled to financial solutions for those who cannot pay in full.

We offer this program to all individuals who are unable to pay for their services. The program eligibility will be based on a person's ability to pay and will not discriminate on the basis of age, gender, race, sexual orientation, creed, religion, disability, or national origin. The Federal Poverty Guidelines are used in creating and annually updating the sliding fee schedule (SFS) to determine eligibility.

The discount will apply to all services received at this office, but not those services which are purchased from outside, such as reference laboratory testing, drugs, x-ray interpretation by a consulting radiologist, and similar services. In the hope that your economic health improves, discounts apply only to current, not future services. An application form must be completed for each visit. All other payment resources must be exhausted including all third-party payments from insurance, Federal, and State programs.

The application form must be completed at least two business days prior to your appointment. You will be notified if your application is approved or denied. If you have not received notification prior to your appointment, your application may not have been received and/or processed for the appointment. If you proceed with your appointment as scheduled you may be responsible for all expenses. If approved, the appropriate discount will be applied to your office visit. If the form is not returned, no discount will be available.

Payment is expected at the time of your visit.

View the current eligibility determination chart

Submitting an application will require uploading proof of income (Tax Return, etc). It is recommended to complete the application on a mobile device with a camera, like a phone or tablet, so you can attach the photos easily.

Get started with your application