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Application for Sliding Fee Discount Program  Form

Application for Sliding Fee Discount Program Form

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Instructions and help about Application For Sliding Fee Discount Program

at Katahdin Valley Health Center our mission is to aid you in removing barriers you may be facing in obtaining health care because we are committed to providing you and your family an easily accessible medical and dental home if you qualify for this discount program you can pay as little as $10 per medical visit $15 per dental visit and receive a discount on your kvh see pharmacy prescriptions to get started just pick up an application at any of our health centers or you can download an application from our website or from your kvh see patient portal the sliding fee discount is based upon household size and household income to apply for the sliding fee discount you will need two forms of documentation of income for each adult in the household if you file a federal tax return just provide a signed copy with the w-2s attached and a second proof of income for each adult in the household if you don't file taxes we would need two forms of documentation for each adult some examples a

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