Sliding Fee Discount Program

SouthRiver Community Health Center is a private, non-profit health clinic that provides quality and affordable medical services.

All patients may apply for a sliding fee discount based on their family/household size and net income, and payment arrangements can be made that are reasonable and mutually beneficial. No one is turned away due to inability to pay.

For patients with private insurance, Oregon Health Plan or Medicare, we bill those insurance plans as a courtesy to our patients.

All patients will receive a monthly statement if there is a balance owed on their account. All balances are due within 30 days of the statement date.

If you are unable to pay your balance in full, you may call our billing department at (541) 492-4550 to make payment arrangements.

Financial Discount Application

To be considered for the Sliding Fee Discount Program, complete SouthRiver’s Financial Discount Application and submit it with acceptable proof of income for all family/household members.

Proof of Income

If you have no proof of income within your family/household, you may submit a Self-Attestation of Income form, which you may obtain from a front desk receptionist or our billing department.

If you do not supply adequate proof of income or you do not qualify based upon the proof of income provided, you will be responsible for the full charges.

You will be expected to pay your portion of the visit fee at check-in for each visit.

Acceptable Proof of Income

  • Copies of the last 3 months of pay stubs
  • A copy of your unemployment verification, if you are receiving unemployment
  • A copy of your most recent federal tax return
  • Copies of other documents to verify income, such as letters from Social Security or Disability Services
  • Copies of food benefit (SNAP) verification, if you receive food benefit
  • If you have no income, a letter that explains your means of living or a completed Self-Attestation of Income form (available upon request)

Sliding Fee Discount Program Services

Not all services are eligible for the sliding fee discount. Below are SouthRiver services that are included in the sliding fee discount program. You will be 100% responsible for the balance due on services that are not included.

Services Included in Sliding Fee Discount Program

  • Office Visits
  • Preventive Exams
  • Medically necessary in-office procedures
  • EKG
  • Breathing tests
  • Behavioral health office visits

Services Not Included in Sliding Fee Discount Program

  • Drug Screens
  • Vaccines
  • Lesion Removal/Destruction
  • Sports Physicals
  • Medications/Supplies

Download this information here.

Where can I get more information?

For more information, contact our billing office at (541) 492-4550.

CourtneySliding Fee Discount Program