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Sliding Fee

An income-based sliding fee program is available for those individuals/families without insurance coverage or who have high deductibles. There is a $20 minimum fee on medical services and a $40 minimum fee on dental services.

The form below is used to apply for our sliding fee scale.  Feel free to print this out and bring with you to your appointment.

Sliding Fee Worksheet (English)

Sliding Fee Worksheet (Spanish)