Sliding Fee Discount Program

HealthSource of Ohio offers a Sliding Fee Discount Program for patients that are uninsured. Eligibility is based on income and family size. Patients may also qualify for the program if they have insurance but cannot afford the deductible. To determine your eligibility, please call your nearest HealthSource of Ohio office to schedule an appointment. You will need to bring income verification with you, which may include:

  • Most recent income tax return or W-2 form
  • Two most recent payroll stubs, if currently employed
  • An eligibility letter for Social Security, Veterans Administration, or for any other benefits you receive (if applicable)
  • Unemployment Determination of Benefits (if applicable)
  • Copy of divorce decree or other court documentation verifying alimony and child support (if applicable)
  • EBT eligibility form to verify benefits (if applicable)
  • Statement giving the amount of gross income per month if you are self or privately employed (if applicable)

If you are determined eligible for the program, you may remain on the program for one year, unless your financial status changes. After one year, we must re-verify your eligibility.

We Offer

  • Improved access to high quality, cost effective primary care services
  • Health care services that are responsive to the needs and values of patients, providers, employers, and consumers
  • Availability of affordable health care to our patients regardless of social, economic, religious, or ethnic status
  • Providing leadership and education for our patients and community. In partnership with our providers, we enable our patients and community to make informed and reasonable health care choices through education
  • Creating a professional environment, which promotes patient satisfaction and pride among staff

You can contact HealthSource of Ohio 24 hours a day, 7 days a week by calling the office of your HealthSource clinician and follow the phone prompts.