Sliding Scale Payment Plan
For Individual Counseling Sessions and Assessments
|
Annual Gross Household Income |
1-2 Dependants |
3-4 Dependants |
5+ Dependants |
|
< 25,000 |
$30 |
$30 |
$30 |
|
25,001-30,000 |
$30 |
$30 |
$30 |
|
30,001-35,000 |
$35 |
$30 |
$30 |
|
35,001- 40,000 |
$40 |
$35 |
$30 |
|
40,001-45,000 |
$45 |
$40 |
$45 |
|
45,001-50,000 |
$50 |
$45 |
$40 |
|
50,001-55,000 |
$55 |
$55 |
$40 |
|
55,001-60,000 |
$60 |
$50 |
$45 |
|
60,001-65,000 |
$65 |
$55 |
$50 |
|
65,001-70,000 |
$70 |
$60 |
$55 |
|
70,001-75,000 |
$75 |
$65 |
$60 |
|
75,001-80,000 |
$80 |
$70 |
$65 |
|
80,001-85,000 |
$80 |
$75 |
$70 |
|
85,001-90,000 |
$80 |
$80 |
$75 |
|
90,001-95,000 |
$80 |
$80 |
$80 |
Group rates are a flat fee of $35 per group session.
Our individual session fees range from $30-$80. ($80 being our highest rate)
To be eligible for these rates, we ask you provide the following:
Proof of Income (If Employed) One of the Following:
o 1040
o W2
o 2 recent pay stubs
o Written statement by employer
Proof of Income (If Unemployed) One of the Following:
o Public Assistance check stub/copy
o Social Security check stub or letter of award
o Certification Letter from Medical Assistance or Department of Social Services
o Written statement from friend or relative with whom patient lives (if other forms not available)
o Letter of reference from a 501 (c)(3) organization, such as a church (if other forms not available)
Proof of Address One of the following:
o Driver’s license
o MVA ID
o Any document (envelope) recently addressed to patient such as a utility bill
o A written statement by relative or friend with whom person lives