Sliding Fee Discount

FCHC is here to help!

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We pride ourselves in never turning anyone away due to inability to pay for service, and we also have a sliding fee scale for the uninsured. Please print the application and bring it with you to your appointment along with an acceptable form of income documentation.

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Acceptable Income Documentation

  • Pay Stubs – 1 month of gross household earnings

  • Unemployment Benefits

  • Workers Compensation Benefits

  • Social Security Benefits – Patient must provide an award letter

  • Child Support

  • Alimony

  • Tax Documents -W2’s, 1099, tax return (adjusted gross income)

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Sliding Fee Application
Sliding Fee Discounts

© 2020 by Fairfield Community Health Center   

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WE ARE DEEMED A FTCA FACILITY

This health center receives HHS funding and has Federal PHS deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.”

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Service (HHS) under grant H80CS19595, of the Public Health Service Act, Section 33, 42 U.S.C. 254b, in the amount of $1,392,607 with 75% financed with nongovernmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S.Government.