Sample Sliding Fee Discount Application

Whether patients are facing financial problems or they don't have insurance, you will always have patients that have difficulties paying for their health services.

If you decide to offer a discount to patients in need, there are steps you must take to not only protect your practice financially, but also to stay within regulatory guidelines.

One way you can offer a financial break to both low income and self-pay patients is to create a sliding fee schedule.

Read 13 Steps to Creating a Sliding Fee Scale for Your Healthcare Practice and download this sample sliding fee discount application (Word doc). Edit it according to your policy.

DOWNLOAD Worksheet

Next Steps

Get a closer look at Kareo's platform

Watch a demo and see how Kareo can help your practice.

Do you have a question or want to learn more?

Chat live with one of our specialists.

Interest in Kareo? Let's talk.

Contact us and a Kareo representative will contact you shortly

Recommended Resources


The combined power of Kareo and PatientPop

As leaders in clinical, financial, and practice growth technology, Kareo and PatientPop have joined forces as Tebra to support the connected practice of the future and modernize every step of the patient journey. Learn more