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Sliding Payment Scale Application

I believe all people should have access to quality health care regardless of insurance status or income, and providing payment according to a sliding scale is one way to facilitate that. I try to balance making my services more accessible while also receiving fair compensation.

Please respond with complete honesty to the following questions about your financial means with either a YES or NO answer.

 

Total up the number of YES responses. Then click the button below to see which payment tier you qualify for.

1. Do you and your household have a source of income or financial support?

    (such as: employment, investment dividends, inheritance, trust fund, or substantial savings)

 

2. Do you live  in a 2-income household?

3. Do you have an income of more than $50,000 per year, or if you are with a partner, a combined income      of  $80,000 or more per year?

4. Are you  financially responsible for 2 people or less (including yourself)? 

5. Based on your income/assets, do you NOT qualify for government funded or other public assistance? 

     (such as MassHealth/Medicaid, WIC, Food Stamps, or Heating Assistance).

            


6. Based on your health and functional abilities, do you NOT qualify for disability benefits (such as                  SSDI)?

 

 

7. Have you NOT had to choose between buying food or paying rent/mortgage or paying other bills such       as for electricity or heat in the past month?

 

8. Lastly, it is none of my business how you choose your financial priorities. When you honestly look at            the spending choices you make, would you be able to shift your resources to invest in your health?

After taking the above questionnaire, if you feel your financial means are not adequately represented and my services are out of your reach, I am open to a conversation about your unique circumstances.

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