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.

  • Driver’s License
  • Recent Utility Bill (gas, electric, or telephone)
  • Voter Registration Card
  • Pictured Identification from employer
  • Birth Certificate
  • 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
  • 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

Revisions Reviewed 1/25/2023