Sliding Scale Fee Program Information Sheet
Download The Information Sheet
As a Federally Qualified Health Center, Grand Peaks offers our patients a sliding fee medical care program based on income and family size according to the federal poverty level guidelines. These rates are available to those who qualify regardless of insured status. Download the information sheet to see what bracket you fall into and the savings you are eligible for.
Apply For The Sliding Scale Program
To apply for our medical care program, 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 three days of your appointment. Otherwise, full fees will be charged.
Patients who wish to apply for the sliding scale program are only required to provide one of the following:
- Two 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) who 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.
