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