Sliding Fee Scale

As a Federally Qualified Health Center, Dahl Memorial Clinic is able to offer patients a Sliding Discount on most clinic services based on household size and gross income.

To apply, submit a completed application along with last year's tax return or your most recent two pay stubs (showing one month's gross income.) You have 60 days from the date of your appointment to turn in the Sliding Fee Scale Application in order to receive a reduction of charges for that visit.

Patients on the Sliding Fee Scale are expected to make at least a $20 payment each visit to the clinic.

Sliding Fee Scale FAQ

  1. Just what is the sliding fee scale?  The sliding fee scale is a discount program the clinic offers through a federal grant for individuals and households who demonstrate financial need.
  2. I have health insurance, can I still apply for the sliding scale? Yes. If you qualify, the discount will be applied to any balance that insurance doesn’t cover.
  3. Do I need to bring my paystubs when I come in for my appointment? If you have them- great! bring them. If you don’t, you have 60 days from the date of your visit to turn in your paystubs or tax return.
  4. I applied for the sliding fee scale last summer when I was working here. Do I have to do it again this year?  Yes, the sliding fee scale must be applied for every year even if your financial circumstances haven’t changed. Once approved, the discount will be honored for 12 months after which you must reapply.
  5. I live with my boy/girlfriend. Do they and their income count as part of my “household”?  It depends. Your household is defined as yourself, spouse, and your dependent family or all people in your residence with whom you are pooling resources and therefore would be recognized as a family.
  6. I have roommates for the summer. Are they part of my household? No, you do not need to include them on your application.
  7. I work 6 months out of the year.  How is my income determined for the sliding fee scale? Income is determined by multiplying your gross monthly wages by the number of months you will be working. Or you can provide your prior year’s tax return.
  8. I am not a US citizen.  Can I still apply for the sliding fee scale?  Yes, anyone can apply.
  9. Can I apply for the sliding fee scale AFTER a clinic visit? Yes, you have 60 days from the date of your first visit to turn in your application.
  10. What services are covered under the sliding fee scale? In general: your office visit, dental services including exams, x-rays, cleanings, and filling, physical therapy, x-rays, ultrasounds and lab tests (that are processed at the clinic), as well as any medications dispensed at the clinic.
  11.  What services are not covered? DOT physicals, vision appointments, some dental procedures, laboratory tests sent to an external lab, some medical equipment, and a few special order medications and vaccinations may not be covered in the sliding fee program. Patients will be notified in advance of any uncovered charges.
  12. If I am currently unemployed but expect to be working soon, how is my annual income determined? Please provide documentation of your unemployment compensation. You may be approved for temporary placement on the Sliding Fee Scale.  You will need to reapply each month you need to visit the clinic while unemployed.
  13. I own my own business, what financial documentation will I need? Please provide your most recently filed 1040 tax form including all attachments. Your gross business income before deductions and expenses is used to determine eligibility for this program.