Eligibility Requirements

Sliding Fee Scale Requirements

You are required to bring the following to your eligibility appointment:

  1. Proof of address - Documentation such as a receipt for rent, mortgage, lease, Arizona Driver’s License or utility bill (electricity, water).
  2. Proof of Identification – Picture identification such as an Arizona Identification Card, Driver’s License or U.S. Passport.
  3. Proof of Income - Documentation of source of income for a one month period, (paycheck receipts, social security documents, unemployment receipt or pension).
  4. Dependent Information – (Birth date, Social Security number)

Fee Schedules - All Services(PDF, 478KB)
Fee Schedules - Dental(PDF, 297KB)
Fee Schedules - Self Pay(PDF, 428KB)

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