Sliding Fee Scale Application

Equitas Health offers discounted medical, psychiatry, and counseling services to patients who are uninsured or underinsured and have low income. The amount you pay is based on the federal poverty levels, your income, and number of dependents.

View Our Sliding Fee Scale

Apply Online

To qualify, please complete the online Equitas Health Sliding Fee Application associated with your Equitas Health Medical Center location, prior to your appointment.

Cincinnati | Sliding Fee Scale Application

Columbus – Short North | Sliding Fee Scale Application

Columbus – King-Lincoln | Sliding Fee Scale Application

Dayton | Sliding Fee Scale Application

Spanish| Sliding Fee Scale Application

French | Sliding Fee Scale Application

 

Apply On Paper

You can also ask for a copy of the application at the registration desk of any Equitas Health clinic location, or print a copy here.

Printable Sliding Fee Scale Application

Got Questions?

A financial counselor will guide you through the process and determine your eligibility. If you have questions about the Sliding Fee Scale, please contact the registration desk of your clinic location:

  • Equitas Health – Cincinnati: (513) 815-4475
  • Equitas Health – Dayton: (937) 853-3650
  • Equitas Health – King-Lincoln: (614) 340-6700
  • Equitas Health – Short North: (614) 340-6777

Learn more about sliding fee scale qualifications

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