Sliding Fee Program

As a Community Health Center, we offer a Sliding Fee Program based on household income and family size, which reduces the amount you pay for healthcare services. If you qualify, you may pay only 20 – 80% of the cost for most services. You may be eligible for this program even if you have insurance. Applications are available at the reception desk at each site, or via the links listed below. All information on the application is kept confidential. We have designated staff available to help you with completing these applications.

Sliding Fee Application Packet – English

Sliding Fee Application Packet – Spanish

Sliding Fee Application Packet – Creole

Federal Poverty Guidelines will be used for the Sliding Fee Program. If your income falls within the guidelines, we encourage you to apply.

Proof of income is required to process your application. A copy of your most recent Federal Income Tax Return is strongly encouraged as proof of income. However, the documents listed below are also acceptable:

• W-2 forms
• Income tax returns
• Social Security notice
• Current pay stubs
• Unemployment award notice
• Letter from employer