In order to determine eligibility for the sliding fee scale, please bring the following:
Proof of Income - Documentation of source of income for a one-month period, (paycheck receipts, social security documents, unemployment receipt or pension).
**If you are unable to bring in proof of income or are unemployed our front office clerks will have you fill out a Self-Declaration at the time of your visit. This form will be used to determine if you are eligible for the Sliding Fee Scale or Under-Insured Program.
Family Size: Husband and wife and their children (see dependent). Unmarried individuals with children in common also can be counted as a household, however, unmarried individuals without children in common are counted separately.