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Sliding Fee Scale

Income Verification

We may likely be able to offer you substantial savings on treatment if you can bring proof of your income for your entire household.

  • Last year's State or Federal tax returns (Federal forms 1040, 1040A, 1040EZ, W-2, Utah form TC-40)
  • Pay-stubs from three consecutive months
  • Voucher from Food and Care Coalition for homeless clients
  • Social Security statement of benefits
  • Veterans Affairs statement of benefits
  • Unemployment workers compensation statement of benefits
  • Federal letter of participation in General Assistance
  • Department of Workforce Services MyCase account

Your proof of income will be used to determine the percentage of treatment costs that you will be responsible to pay if you do not have other applicable coverage.

2018 sliding fee scale effective 2017/09/01