Willamette Dental Group offers a sliding fee scale at participating locations to offset the cost of care for uninsured and low-income patients. Discounts are offered based on family size and annual income. Patients must complete an application[WA1] to receive discounted service. Patients can download it and bring into one of the participating locations or email the completed application to Member Services via our secure email by clicking here. Click here for instructions on how to use our secure email.
To qualify, patients must report all sources of income for the last 12 months and provide proof of income from at least one of the following:
- 2 most recent pay stubs or unemployment stubs
- Most recent tax return
- Award letter from SSI (Supplemental Security Income) or SSD (Social Security Disability)
- TANF (Temporary Assistance for Needy Families) statement from the state Department of Human Services
Patients who do not have proof of income must provide a brief statement describing how they are supporting themselves.
In addition to quality care, you have the option of financial counseling by someone who can understand and offer possible solutions if you cannot pay in full. Our staff will work with you to find reasonable payment options.
We will not discriminate on the basis of age, gender identity, race, sexual orientation, creed, religion, disability, or national origin. The Federal Poverty Guidelines (FPG), http://aspe.hhs.gov/poverty, is the criterion used in the creation of and annually updating to the sliding fee schedule (SFS) for eligibility determination.
The current locations accepting SFS applications are:
- Lincoln City
- Portland – Lents
- Portland – Stark 1
- Portland – Stark 2
To download the application click on the link below: