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Reduced Fee Request

Please complete the following:

  • We can provide you more specific fee information based on the service you are requesting if you are eligible for a reduced fee - full fee is displayed. A payment plan would divide the fee into six (6) equal payments.
  • You may estimate, but we will require proof of income at the time of service (tax forms, pay stubs, etc.).
  • Dependents being claimed on parent's income tax returns, such as college students up to age 24, may include all still living at home.
  • Max. file size: 2 MB.
    If you have an electronic copy of your annual tax return or recent pay stubs, you may upload a copy here.