The form below is required if you are applying for our sliding fee scale. You will also need to schedule an intake appointment to go over the form with our intake staff.
Instructions on how to obtain an IRS Verification of Non-Filing Letter "Click Here"
Please Call to schedule an appointment or to get additional information.
To schedule an appointment or for more information please call us at (307) 635-3618.
If you are experiencing severe symptoms, please call 9-1-1 NOW.