Sliding Scale Medical Discount Information Sheet
Download The Information Sheet
As a Federally Qualified Health Center, Grand Peaks offers a sliding fee medical care discount to our patients based upon income and family size according to the federal poverty level guidelines. These discounts are available to those who qualify regardless of insured status. Download the information sheet to see what bracket you fall into, and the discounts you qualify for.
Apply For The Sliding Scale Discount
To apply for our medical care discount, please complete the Sliding Scale Application. The information on this application also has to be verified and proof of income must be submitted to our facility within 3 days of your appointment, otherwise full fees will be charged.
Patients who wish to apply for sliding fee discounts are only required to provide one of the following:
- 2 most recent pay-stubs for all members of the household who are working
- Previous year’s tax documents
- Social Security or Disability income statements
- If you have no verifiable income, a letter from someone close to you (may not be a family member) that can verify your income and financial situation. This letter must be signed and dated, and a phone number to reach this person is required.
- If you have recently started a new job, the employer may either write a letter or you may have them complete our Income Verification form. This form must be signed and dated.
