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407-905-8827

Orange County

352-314-7400

Lake County

Sliding Discount Application Form

We Serve All Patients, Regardless of Their Ability to Pay

Our Sliding Discount Program reduces the cost of care to our uninsured patients based on their income and family size. Patients with insurance may also benefit from this program.

Discounts are offered depending upon household income and size. A “Family” is one or more persons living in one dwelling place who are related by blood, marriage, or law. Adults and minor children are considered a family. Relatives over 18 (that are not full-time students) are not eligible to be used as dependents for this application process.

Please complete the following questions to determine if you or your family members are eligible for our Sliding Discount Program.

After completion of this form, if you’ve not already requested an appointment, please call us at 407-905-8827 or use the online appointment request form.

To protect your privacy, please refrain from providing personal health information or any other sensitive information via contact form. A patient service rep will contact you and request the needed information.

Orange County

Lake County

Our mission is to provide quality and compassionate primary healthcare services to Central Florida’s diverse communities.