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1. Schedule an appointment with one of our Patient Access Representatives.

2. Complete the Sliding Discount Program Application Form.

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Documents to Provide on the Day of Your Appointment:

Proof of Identification:

For Adults: One (1) identification is required with a picture ID. If no picture ID is available, bring two (2) of the following (e.g., birth certificate, social security card).

• Current Driver’s License
• State Identification card
• Legal Resident documents, Passport or Consulate card

If no picture ID, bring two (2) of the following:

• Birth Certificate
• Social Security card
• Marriage license
• Selective Service Card

For Children: Bring two (2) of the listed documents.

• Birth Certificate
• Social Security card
• Verification of Birth Facts from Hospital

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Proof of Income (as applicable):

Earned income

• Pay stubs showing last four (4) weeks of income
• IRS Tax record transcript (request online @ www.irs.gov or 1-800-908-9946)
• Statement from employer with company’s information

Unearned income

• Recent TANF letter from Texas Department of Human Services
• Social Security Supplement from Social Security Administration
• Child support award letter from Attorney General
• Retirement Pension award letter
• Veteran’s pension letter
• Unemployment award letter from Texas Workforce Commission
• Workers’ compensation letter

Self-employment

• Declaration letter for last 2 months
• IRS Tax record transcript (request online @ www.irs.gov or 1-800-908-9946)

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Proof of Residency:

Utility bills – most recent

• Electric bill
• Water bill
• Natural Gas bill

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Food stamp letter

Lease from dwelling (house, apartment, etc.)

Letter of residency verification