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:

New Patient Intake Form – English
Información del paciente nuevo – Español

Got questions?

Click here to send us an email.

Call for Appointment
Call us, then press 6.

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.

Sliding Fee Scale Discount Application – English
Formulario para solicitar descuento de pago basado en sus ingresos – Español

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.

Examples include:

• 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, children attending college up to the age of 26, and any individual whom the applicant has legal responsibility for that is shown as a dependent on the taxes are also included in determining the total number of individuals in a household. 

 *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: One months’ worth of pay check stubs and those pay check stubs of family members living with you who quality as part of the household. Other documents you can provide if you do not have any of the documents mentioned above can be found below.

Proof of Income – English
Comprobantes de ingresos – español

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.