Revisions Reviewed 1/25/2023
Information for Patients – Required Documentation
Please call (973)789-8111 to find out more on our sliding fee discounts available to all patients. Discounts are based on income and family size which are verified by the following documents.
Identification and Proof of Residence
- Driver’s License
- Recent Utility Bill (gas, electric, or telephone)
- Voter Registration Card
- Pictured Identification from employer
- Birth Certificate
Proof of Income
- W-2 Income Tax Withholding Form
- Unemployment Insurance
- Letter from employer on their letterhead stating annual income (employer’s telephone should be available for confirmation of information) or Notarized letter indicating source of income
Proof of Age and Family Size
- Birth Certificate
- Driver’s License
- Marriage License
- Baptismal Certificate
- W-2 Income Tax Withholding Form
***If the patient fails to produce the appropriate documentation which satisfies the above-mentioned criteria after the second visit, that patient may billed at the full rate.***
SLIDING FEE BREAKDOWN
