No health or prescription insurance, Medicaid, or CHIP?
We can help!
Sliding Fee Discount Program
Our patient assistance program gives you a percentage discount on our services, including discount medications from our Smithville Clinic In-House Pharmacy! Your exact discount is calculated based on your household size, household income, and the Federal Poverty Level (FPL). We can provide help for those with a household income below 200% of the FPL. Once your application is approved, your discount can be used at any Access Family Health location, including our in-house pharmacy and Dental Clinic.
No income? You may still qualify.
- Find Out If You Qualify -
|Annual Household Income|
Using the chart above, find the number of people in your household and determine if your annual household income is greater than the amount shown.
If it is greater, unfortunately you don't qualify.
If it is less than the amount shown, then you qualify!
If you qualify and want to apply, you can...
download and print the application
call any of our locations to request a mailed copy
stop by one of our locations and pick one up
Completed applications, along with all required documentation, can be...
scanned and emailed to firstname.lastname@example.org
Free scanning apps can be found on the App Store or Google Play Store.
Documents must be in one of the following formats:
dropped off at any of our locations, or if you already have an appointment scheduled, simply bring them with you and give to the receptionist at check-in.
A list of required documentation and other program info can be found in the Sliding Fee Application Packet.