How to apply
We recommend applying for the Sliding Fee Program the first time you visit. Our front desk staff can provide you with the form and instructions. Eligibility for the Sliding Fee Program depends on your income and the number of people in your family. You will need to bring a document to prove your income, such as:
- Paycheck stub (from last 12 months)
- 1040 tax return (from last 12 months)
- Disability or Social Security letter (from last 12 months)
- Unemployment statements (from last 6 months)
- Denial for Medicaid services or food stamp eligibility (from last 6 months)
- Letter from church representative (from last 3 months)
- Statement from probation officer (from last 3 months)
- Recent release from jail or prison (from last 3 months)
If you apply for the Sliding Fee Program at your first visit and qualify, you can receive a discount on that visit without proof of income. To continue to get a discount on care, bring your proof of income as soon as possible.
If you “self-declare” your income and do not bring proof of income to your next visit, you will be responsible for paying the full amount for services until you submit proof of income.
Frequently Asked Questions
Good Faith Estimates
How to Find Out More
If you have any questions about our Sliding Fee Program, Good Faith Estimates, or other payment-related questions, please reach out to our Billing Department at 616-965-8282 to speak to a billing coordinator.