Our Financial Assistance Program offers reduced prices on office visits and services provided at Burgess Health Center and Burgess Clinics to all individuals and families who qualify. This does not include specialists or providers who bill separately from the Burgess billing system.
The program is based on family income and may reduce your bill. You may qualify with or without insurance, and you may qualify even though you have Medicare or Medicaid.
To apply, submit the following:
- Copy of the front page of your most recent income tax return, showing your annual gross income
OR three months of pay stubs for each working family member - If applicable, your recent Medicaid application
- Completed Financial Assistance application.
Applications are available at any of our locations – just inquire at the front desk.
You may also print an application.
You may view full copies of the following:
- Burgess Health Center Financial Assistance Policy (plain language)
- Burgess Health Center Financial Assistance Policy
- Burgess Clinic Financial Assistance Policy
- Providers that follow Burgess Health Center Financial Assistance Policy
- Providers that DO NOT follow Burgess Health Center Financial Assistance Policy