• Link to Facebook
  • Link to X
  • Link to LinkedIn
  • Link to Instagram
(703) 443-2000
  • About
    • About HealthWorks
    • 2022 – 2024 Strategic Plan
    • Our CEO-In The News!
    • Our Healthcare Providers
    • Leadership and Community Partners
    • Employment Opportunities
    • Volunteer Opportunities
  • For Patients
    • Become a Patient
    • Request an Appointment
    • Sliding Fee Discount Program
    • Telehealth
    • Patient Portal
    • Online Bill Pay
    • FAQs
  • Services
    • Medical Services
    • Behavioral Health
    • Dental Services
    • Specialty Care & Services
    • Imaging Services
    • Pharmacy Services
    • Prescription Assistance Program
    • Health Insurance Enrollment Assistance
  • Locations
    • Leesburg Location
    • Herndon Location
    • Reston Location
    • Sully (Herndon)
    • Sterling
  • Support Us
  • Contact
  • Become a Patient
  • Donate Now
  • Click to open the search input field Click to open the search input field Search
  • Menu Menu

Sliding Fee Discount Program

HealthWorks for Northern Virginia is pleased to offer our medical, dental and behavioral health care services at a reduced cost to our low income, insured and uninsured patients through our Sliding Fee Discount Program.

To be eligible for the Sliding Fee Discount Program, you will need to provide documentation of annual household income not exceeding two times the federal poverty level, depending on the number of people living in your household and your combined household income.

Patients, including those with insurance, whose income is at or below 200% of the Federal Poverty Level, qualify for our Sliding Fee Discount Program. For patients who qualify, the office fee ranges from $35 to $65 dollars, plus additional fees if necessary.

No patient will be denied care due to an inability to pay or because they do not have insurance.

How does the program work?

Prior to, or on the day of, your first visit, you will be asked to bring proof of your annual household income and size. When you arrive, you will be asked to complete a Sliding Fee Discount application, new patient registration form and provide the necessary information to help us determine the discount to which you are entitled.

What income documents must I provide?

Tax returns, pay stubs, bank statements or a letter from your employer verifying your employment status (or the Employment Verification form) are examples of proof of income documents. If you do not have income, you may provide a letter from the person who supports you or complete the Self Declaration of Income form. Employment Verification and Self Declaration or Income forms are available at any of our centers in English and Spanish.

Sliding Discount Fee Document & Form Downloads

  • English

  • Spanish

  • 2024 Poverty Guidelines and Slide Discounts
  • Sliding Fee Discount Application
  • Self Declaration of Income
  • Employment Verification Form
  • 2024 Poverty Guidelines and Slide Discounts
  • Sliding Fee Discount Application
  • Self Declaration of Income
  • Employment Verification Form

For Patients

  • Become a Patient
  • COVID-19 Updates
  • Request an Appointment
  • Sliding Fee Discount Program
  • Telehealth
  • Patient Portal
  • Online Bill Pay
  • FAQs

Do you have questions about HealthWorks or our services?

Contact Us

Leesburg

163 Fort Evans Road NE
Leesburg, VA 20176
More Location Information
Fax Number
703-443-2033

Dental Suite 1st Floor.

Herndon

1141 Elden Street, Third Floor
Herndon, VA 20170
More Location Information
Fax Number
703-435-6752

Dental Suite 218

Reston

11484 Washington Plaza West
Reston, VA 20190
More Location Information
Fax Number
703-657-2142

Sully (Herndon)

13800 Wall Road, Suite 055
Herndon, VA 20171
Fax Number
571-306- 7741

Sterling

21641 Ridgetop Circle, #107
Sterling, VA 20166
Fax Number
703-443-2033

For non-emergencies, current patients can reach our after-hours service by calling: 703-443-2000.

HealthWorks for Northern Virginia health centers are Federal Torts Claims Act (FTCA) deemed facilities. HealthWorks is a 501(c(3) nonprofit community-based Federally Qualified Health Center (FQHC). HealthWorks is a Health Center program grantee under 42 U.S.C. 254b, and deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).

Translate Website

Website translation provided by Google Translate.

© HealthWorks for Northern Virginia. All rights reserved. | Home | Contact Us | Privacy Policy
  • Link to Facebook
  • Link to X
  • Link to LinkedIn
  • Link to Instagram
Scroll to top