Call for information or an appointment.
Suburbs call 847.666.3494
Paying For Your Visit
At Erie no-one is ever turned away because of their ability to pay. We accept patients who have insurance and patients who do not have insurance.
For Patients With Insurance
Erie Family Health accepts many different forms of insurance.
Payment is preferred at the time of service.
Please print and fill out the new patient intake form (below) prior to your visit, and bring it with you to your appointment:
Click here to send us an email.
Sliding Fee Scale
Patients without insurance or patients with high deductibles qualify for the sliding fee scale discount.
Even if you have insurance, you may be able to use our sliding fee scale discount program. Please read the below information below, as well as print, read, and fill out the application below and bring it to your next appointment to see if you qualify for this program.
Qualified patients are charged on a sliding fee scale, which is based on family size and household income. In order to qualify, patients must provide proof of identification, proof of family size and proof of income. This information must be renewed every 12 months.
- Identification: State driver’s license, State Identification Card, Matricula Consular de Alta Seguridad (Identification card issued by the Government of Mexico), Passport, or similar identification from other countries of origin.
- Family size: Includes any dependent children, Spouse or Partner, Parent or in-laws, any individuals over the age of 18* for whom the applicant has legal responsibility to support living in the home, **children attending college up to the age of 26 are also included in determining total number of individuals in a household.
* For any individuals for whom you have legal responsibility for you must present court documents to verify any additional individuals supported over the age of 18.
**For children attending college you must provide a schedule or transcripts that can be utilized to verify support provided to children ages 18-26.
Income: Your pay check stub (last 30 days) and those of family members living with you, AND a copy of your most recent Tax Return and any tax returns of those living with you who are not included in your tax return. Other documents you can provide if you do not have any of the documents mentioned above can be found below.
Our front desk staff will use this information to determine your fee. And if you pay on the same day as your appointment, we will provide a discount.
Our front desk staff will be happy to go over the details of your specific situation.
Note: if you have questions about your bill, call 312-666-3494 (city) or 847-666-3494 (suburbs); press 1 for Spanish or 2 for English, then press 4 and then 3 to speak to our patient billing department.