Sliding Fee Discount Application/Aplicación de Descuento por Tarifa Corriente
Discounts are offered based on family size and annual income. Please complete the application and return to the front desk to determine if you or members of your family are eligible for a discount. The discount will apply to all services received at this clinic, but not those services or equipment that are purchased from outside, including reference laboratory testing, drugs, and x-ray interpretation by a consulting radiologist, and other such services. This form must be completed every 12 months or if your financial situation changes.
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