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Click ‘Get Form’ to open the sliding scale agreement in the editor.
Begin by reviewing the annual income brackets listed. Identify your income range and note the corresponding fees for both interns and licensed mental health professionals.
If applicable, document any extenuating circumstances regarding your ability to pay in the designated area below the fee schedule.
Read through the financial agreement section carefully. Ensure you understand that payment is due at the beginning of each session and note any fees associated with returned checks.
Sign and date the form in the provided fields to confirm your agreement with the fee schedule.

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What is an example of a sliding scale?

Sliding Scale Examples Example 1: A therapist charges $150 per session at their regular rate. They have a sliding scale from $150 to $50. The scale might look like this: Income above $75,000: $150 per session.

What does sliding scale mean in business?

Sliding scale fees are variable prices for products, services, or taxes based on a customers ability to pay. Such fees are thereby reduced for those who have lower incomes, or alternatively, less money to spare after their personal expenses, regardless of income.

What is a sliding scale agreement?

Sliding scale fees are fees for services that are adjusted depending on an individuals income. Theyre usually set to provide fairness and address income inequality. The higher your income, the more youll pay. The lower your income, the less youll pay.

What does a sliding scale mean?

a system in which the rate at which something is paid changes as a result of other conditions: Charges are made on a sliding scale, which means that the amount you must pay increases with the level of your income.

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