On Demand Counseling allows patients to apply for a reduction in cost of services if the patient informs the clinic that they cannot make the full payment amount. If you feel that you cannot meet the payment amounts for services needed, you may apply for a reduction in cost by filling out this form. If you meet the criteria for a financial hardship, a determination of cost will be made. No person will be denied care based upon inability to pay for services.
The financial hardship form must be completed for cash paying patients not able to pay the initial fee.