Sliding Fee Scale Program

About our Sliding Fee Scale Program

The Haven will offer a Sliding Fee Discount Program to those who have no means, or limited means, to pay for their healthcare services. The Haven will base program eligibility on a person’s ability to pay and will not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. A calculation of the percentage of the Federal Poverty Guidelines is used in creating and annually updating the sliding fee schedule to determine eligibility. 

If you believe you qualify for this program, please fill out and sign the application and return to The Haven via email or fax to 520-623-2065. When you submit your application, please include copies of your two latest pay stubs.