Sliding Fee Discount

Sliding Fee Discount Program

To be screened for eligibility for the Sliding Fee Discount applicants must also provide family size and proof of earned income through one of the following document(s):

• Current Federal income tax return

• Social Security or disability letter (must be a letter from Social Security Administration)

• 30 days paystubs (most recent)

• Unemployment Benefits (must be a letter from Unemployment department)

• Letter from a shelter on organizational letterhead where applicant resides

• Letter from employer on company letterhead documenting the hours worked and rate of pay or signed and notarized GSCC Employer Declaration Notice

• Department of Human Services Child Support Statement or proof of alimony

• Self-declaration on GSCC Self-Declaration Form is allowed for homeless individuals/families

ALL paperwork must be completed prior to being seen at the clinic.

TO QUALIFY FOR A SLIDING FEE DISCOUNT:

Patients must provide family size and proof of income that verifies income levels are at or below 200% of the Federal Poverty Level.

Click here to view the Sliding Fee Discount Schedule (SFDS)