Sliding Fee Application Form - Turning Leaf Counseling Inc 2026

1. Click ‘Get Form’ to open the Sliding Fee Application Form in the editor.
2. Begin by entering the 'Date of Completion' at the top of the form. This helps track when your application was filled out.
3. Fill in the 'Referral Source' field to indicate how you were referred to Turning Leaf Counseling Inc.
4. Complete your personal information, including 'Patient Name', 'DOB', 'Race', and 'Sex'. Ensure accuracy for proper identification.
5. Provide your address details, including 'City', 'State', and 'Zip Code'. This is essential for communication purposes.
6. If applicable, complete the section for additional income contributors by filling in their details such as name, DOB, and employment information.
7. In the income verification section, list all household members contributing to income along with their sources and amounts received. Be thorough to ensure accurate assessment.
8. Finally, review all entries for completeness and accuracy before signing. Ensure that you understand your financial responsibilities as outlined in the form.

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