Financial Assistance 2019-04-15T17:27:01+00:00

Financial Assistance

Sliding Fee Discount Program

Siskiyou Community Health Center serves all patients regardless of ability to pay. Sliding fee discounts are offered depending upon family size and income.

To be considered for this program you need to complete an application and submit acceptable proof of income for all adults in the household. If you do not supply adequate proof of income or you do not qualify based on the proof of income received, you will be responsible for the full charges.
Once you have qualified for the program you will be eligible until March 31st. A new application and proof of income is required each April 1st or your first visit after this date.
You will be expected to pay your portion of the visit at check in for each visit.

Household Member Guidelines:

  • Includes yourself, spouse and dependents under the age of 19.

  • Any other adult living in the home, even if they are related, would not be included in the household count. They would need to complete a separate application. (Some exceptions do apply)

Acceptable Proof of Income:

  • Pay Stubs: A full month’s worth of Pay Stubs for the most current month (2 months if paid monthly). Must include employer name, pay period and gross wages.

  • Letter of Determination: Social Security, Disability, Unemployment (must show gross weekly amount), Child support/alimony, Worker’s Compensation.

  • Self Employed applicants: Copy of your most recent Federal Tax Return (1040) with signature page. (Do not submit W-2s or 1099s).

  • Students: Financial Aid Award Letter

Download Application (English)
Download Application (En Español)

Frequently Asked Questions:

The slide program at Siskiyou Community Health Center is a federal program that allows us to offer discounts on our services to patients who may not have the ability to pay full fees.

Eligibility is based on your household size and income

The slide program is available to all of our patients, even those who have insurance including Medicare, Oregon Health Plan and/or private insurance. Applying for our Slide Program has no impact on your current insurance coverage.

The household includes yourself, spouse and any dependents under 19 years old that live with you. If you have a dependent that is a full time student under the age of 23 you can include them in your household if you claim them on your tax return. You will be asked to submit the most recent tax return as proof. Any other adults in the household, even if they are related, are not included.

Our slide discounts apply to all services at Siskiyou Community Health Center, including in-office procedures, dental care, pharmacy, and in-house labs.

While your insurance may cover many of the services you receive, the slide program may be able to assist on the balance due after insurance pays, such as copays, coinsurance or deductible amounts. It may also help reduce the cost of services your insurance may not cover such as labs, pharmacy or dental care.

You will need to complete a one page application and submit proof of income for every adult listed in the household. If you do not have proof with you today, please talk to the Registration Staff regarding your options. Once your application is approved it is valid until March 31st. A new application and proof of income will be required on or after April 1st each year to continue to be considered for the slide program.