Sliding Fee Scale

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Sliding Fee Schedule

As a Federally Qualified Health Center, Partnership Health Center is able to offer most services on a Sliding Fee Scale (SFS). This means that depending on your family income and family size, you may be eligible for greater discounts.

Sliding Fee Scale 


Sliding Fee Scale Eligibility

In order to access the SFS discount, you must provide one of the following items as proof of your financial status. Please bring it with you on the day of your appointment.

  • 1040 Tax Form for the most recent calendar year
  • One Month of Consecutive Pay Stubs (If no tax return filed in past year)
  • Social Security Letter
  • Food Stamps Benefit History (CHIMES Report)
  • Pension Letter
  • Grant Letter (Students only)
  • Patient Self-declaration
    (Income statement with patient signature; must be witnessed and signed by a PHC staff member)

If you prefer, you can also download our Patient Intake form and fill it out in advance of your next appointment. 



Still have questions about our Sliding Fee Scale? 

Please inquire at the front desk or call us at 258-4450.



Need help finding insurance under the Affordable Care Act (ACA)?

PHC has Certified Application Counselors available to help individuals and families who have questions about the ACA or who need assistance obtaining health insurance. You do not need to be a patient of PHC to utilize this resource! 

For more information, call 258-4450.