Dental Office Application With Sliding Scale In Allegheny
Category:
State:
Multi-State
County:
Allegheny
Control #:
US-00413-1
Format:
Word;
Rich Text
Instant download
Description
This form is an Employment Application. The form provides that applications are considered without regard to race, color, religion, or veteran status.
Free preview
Form popularity
More info
✓ The nominal range on the sliding fee does not apply to Dental Services. Apply online using COMPASS.COMPASS is an online platform which makes it easy to apply for, or renew, your benefits. Accepts most third-party payments including state Medical Assistance plans and private insurance. Sliding scale fees are available for people without insurance. Federally Qualified Health Centers or Sliding Fee Clinics. I made a map of all the free (and sliding-scale) clinics in Allegheny County: medical, dental, and behavioral. Download and print the AHN Financial Assistance Application. Complete the form and submit it with required proof of income. A sliding-fee scale is available to help reduce out of pocket expenses.