Below, you will find different sets of sliding scale applications. Although the actual application is the same, the requirements and attachments for each category is different. Please choose the one that best describes your situation. Please be advised that an incomplete application or failure to submit the required documents will result in the immediate denial of your application.
Currently employed sliding scale applicants must submit the application as well as the following forms to be considered for the Sliding Fee Scale Discount.
Self-employed sliding scale applicants must submit the application as well as the following forms to be considered for the Sliding Fee Scale Discount and submit the required documentation as well.
The Application and all Proof Of Income can either be faxed to us at (573) 332-7998, or it can be emailed to us at capefamilymedicalclinic@gmail.com or you may submit it to us directly at the clinic.
Unemployed sliding scale applicants must submit the application as well as the following forms to be considered for the Sliding Fee Scale Discount and submit the required documentation as well.
The Application, the two Circumstance Verification Forms and the Monthly Expense Verification Form can either be faxed to us at (573) 332-7998, or it can be emailed to us at capefamilymedicalclinic@gmail.com or you may submit it to us directly at the clinic.
* This practice services all patients regardless of the ability to pay. Discounts for essential services are offered based on family size and income.
** To view the actual sliding scale, you can do so by clicking here.