Discount Fee Program Application

Discount Fee Program Application

The Discount Program assures that patients have access to all services (Medical, Pediatric, OB-GYN, Dental and/or Behavioral Health) regardless of their ability to pay. At the Center, we provide access to quality healthcare regardless of insurance status. We accept most private insurance, Medicaid, FAMIS, Medicare and offer a discount fee program. Eligibility for the discount fee program is based solely on income under Federal Poverty Level guidelines and family size. We encourage you to apply for our Discount Program, which provides qualifying patients with significant discounts for health care services. If you wish to apply for the program, please contact our center to schedule an appointment with one of our coordinators.

What income documents must I provide?

1 Month Recent Pay stubs, (or self-declaration of income form) are examples of proof of income documents. If you do not have income, you may come into your appointment and one of our coordinators will further assist. Self-Declaration of Income forms are available on our website and at any of our centers in English and Spanish.

Go to our Patient Forms & Portal page to download registration forms and for a list of items you should bring to every appointment for a faster check-in experience each time you come to the Center.