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  • Estimate Your Service Discount

    This health center serves all patients regardless of ability to pay. Discounts for essential services are offered based on family size and income. For more information, call us at (317) 291-7422.
  • Cost Estimate

  • Please complete the questions above to see your cost estimate.

  • Level A

    Based on your household size and income level, you will be asked the pay the following amounts for your visit:

    Flat Fee: $10.00

    This is the only fee you will be asked to pay for services during your visit.

  • Level B

    Based on your household size and income level, you will be asked the pay the following amounts for your visit:

    Nominal Fee: $20.00
    Service Cost: 20%

    You will receive an 80% discount for the services you receive during your visit.

  • Level C

    Based on your household size and income level, you will be asked the pay the following amounts for your visit:

    Nominal Fee: $30.00
    Service Cost: 40%

    You will receive an 60% discount for the services you receive during your visit.

  • Level D

    Based on your household size and income level, you will be asked the pay the following amounts for your visit:

    Nominal Fee: $40.00
    Service Cost: 60%

    You will receive an 40% discount for the services you receive during your visit.

  • Level E

    Based on your household size and income level, you will be asked the pay the following amounts for your visit:

    Nominal Fee: $50.00
    Service Cost: 80%

    You will receive an 20% discount for the services you receive during your visit.

  • Level F

    Based on your household size and income level, you will be asked the pay the following amounts for your visit:

    Nominal Fee: $75.00
    Service Cost: 100%

    You be asked to pay for the cost of the services you receive during your visit.

  • Great! We will walk you through the steps of submitting the necessary information. Click the Next button below to get started.

  • Sliding Fee Discount Program Application

    Please complete the following form to apply for the sliding fee discount program.
  •  -  -
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  • Necessary Documents

    The below is a general list of items that you may need during the application process. If you are unsure whether or not an item applies to your application, please call a financial counselor by calling 317-291-7422. You can upload the documents in advance of your appointment using this page.
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