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Sliding Fee Application Form

263.40 KB 1525 1 Files
Rachel Krino Published March 8, 2022 · Updated June 13, 2025
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Description

Please download, print and complete this form for the Sliding Fee Program

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The Bellaire and East Jordan Family Health Center is experiencing issues with our internet systems. This has also impacted our East Jordan location phone systems. We are working to resolve this issue with Charter. Thank you for your patience.

The Patient Portal will be unavailable October 18-20, 2024 due to scheduled maintenance. We apologize for the inconvenience.