​Sliding Fee Discount Program

Redwood Coast Medical Services (RCMS) serves all patients regardless of their insurance or financial status. As a federally funded Health Center, we are able to offer discounted medical, dental, and behavioral health services through a sliding fee schedule to patients who qualify based on household size and gross income.

Application

To apply fill, out the Patient Financial Screening Form below:

How will my discount be determined?

After completing the Patient Financial Screening Form, your total monthly gross income and the number of people you are financially responsible for in your household, will be used to determine the level of discount that you and your family are eligible to receive.

For More Information Call:
(707) 882-2189

Proof of Income

RCMS staff is available to assist patients in determining if they are eligible for our Sliding Fee Options. Applicant must provide proof of income within 30 days for slide to be effective for one year otherwise it will expire.  You can reapply as needed. Examples of proof of income include:
  • W-2 form
  • Last year’s income tax return
  • Most recent pay check stub
  • Unemployment check stub
  • Notification of Benefit for disability income
  • Social Security payment letter or bank statement showing proof of direct deposit of Social Security income
  • If self-employed, either prior year’s Schedule C income statement or quarterly profit and loss statement
  • Worker’s Compensation stub or proof of direct deposit
  • Signed personal letter stating declaration of income such as income from boarders, odd jobs, or assistance from charity, family for friends
If you are unable to provide RCMS with one of the approved forms of income documentation, please call 707-882-2189 for assistance.