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General Information | Primary Care | Specialty Services | Additional Services

OMC Sliding Fee Scale Program

Oakhurst offers a Sliding Fee Scale Program to patients who qualify.  Your enrollment in this program is based on your household income and family size. To apply for the Sliding Fee Scale Program, patients must supply required documentation; including valid photo identification, proof of income for the past 30 days and current address verification.  Patients are required to recertify every six months.

Valid forms of identification

One of the following:

  • Drivers License
  • Passport
  • Current College ID Card
  • US State-Issued ID Card
  • US Immigration Photo ID Card
  • Military ID Card
  • Foreign ID Card

Valid proof of residency

One of the following:

  • Current telephone bill
  • Current gas bill
  • Current water bill
  • Current electric bill

If your name is not reflected on any of the bills, you must also bring a letter from the bill holder stating that you reside at the address listed

Valid proof of income

One of the following:

  • Income Tax W2 Form or 1099 Form
  • Payroll check stub(s) from employer  equaling last 30 days of employment
  • Weekly – 4 check stubs
  • Bi-Weekly – 2 check stubs
  • Monthly – 1 check stub
  • Current Food Stamp Summary Notification Sheet*
  • Disability/Worker’s Compensation Notification Form*
  • Medicaid/Medicare Form or Card*
  • Social Security Notification Form*
  • Pension/Retirement Statement*
  • Unemployment Eligibility Sheet, Checks or Check Stubs*
  • Veterans Benefit Statement*
  • Official Documentations from another Social Services Agency
  • Wage statement (Form W615) from the Georgia Department of Labor*
  • Full/Part-time Students:
  • Financial Aid Statement
  • Work Study Notification
  • Verification of Parent’s Income

*MUST INCLUDE AMOUNT OF FINANCIAL BENEFITS

 
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Oakhurst Medical Centers is an FTCA deemed facility.