Get Nm Sierra Vista Community Health Center Sliding Fee Scale Application

Completing the NM Sierra Vista Community Health Center Sliding Fee Scale Application online is a straightforward process designed to help you access essential health services based on your financial situation. This guide will provide step-by-step instructions to assist you in filling out the application accurately and efficiently.

Follow the steps to complete the application successfully.

1. Click ‘Get Form’ button to obtain the application form and open it in the necessary editing tool.
2. Begin by entering the name of the head of household in the designated field. This information is essential for identifying your application.
3. Fill in the address, including the state, city, and zip code. Make sure this information is current and accurate to avoid any delays in processing.
4. Provide a phone number where you can be reached. This contact information will be important for follow-ups regarding your application.
5. List yourself, your spouse, and all dependents under the age of 18 in the specified section. Make sure to include their names and dates of birth.
6. Complete the income section by listing all sources of income for yourself and your household. Ensure that you detail gross wages, unemployment compensation, social security, and any other regular income sources.
7. Calculate your total income and enter this amount in the designated field. If necessary, be prepared to provide verification documents such as tax returns or pay stubs.
8. Certify the accuracy of the information provided by signing and dating the form at the bottom. Your signature confirms that all details are correct.
9. Finally, review the entire application to ensure accuracy. Once confirmed, you can save changes, download, print, or share the completed form with the Financial Counselor.

Start completing your application online today to ensure you receive the necessary health services based on your eligibility.