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For Patients

Patients who do not have dental or medical insurance

Part of our mission is to see the uninsured and underserved of our community.  We are able to do this by offering a sliding scale discount based on income to our uninsured patients. Your income information is completely confidential and is not provided to any governmental agency for any reason. No one will be denied access to services due to inability to pay, The available discounted/sliding fee schedule is based on family size and income.

Please provide the following income documentation to confirm eligibility for the sliding scale. This information will have to "updated" every six months to keep the sliding scale discount. Income can be documented based on one (1) of the following pieces of information:

  • Paystubs for the last month. This means 4 weeks of paystubs.

    • If you are paid every two (2) weeks  this means two (2) paystubs. 

    • If you are paid every four (4) weeks this means four (4) paystubs. 

  • SNAP or TANF benefit statement.

  • Social Security (SSA)  benefit statement.

  • Unemployment statement.

  • Your most recent tax return (accepted through June).

  • Statement of earnings from employer; to include pay rate, estimated hours and frequency printed on company letterhead.

  • If you are unemployed we have a letter of Financial Support for a family or friend to complete and sign who is providing support. This letter is confidential and not supplied to any other agency for any other reason. For the letter in English click here. For the letter in Spanish click here. 

 

If possible please provide your income documentation before your visit so your check in process will be brief and your wait time minimized. There are four ways for Olde Towne to receive your information:

  • in person to the front desk

  • email to office@otmdc.org

  • fax to 757-220-1953

  • mail to OTMDC, 5249 Olde Towne Road, Williamsburg, VA 23188

Every six months your sliding scale needs to "updated." This means that every six months you need to bring in current income information again before or at your next appointment.

If you have not provided the requested documentation at the time of your appointment, you will have 24 hours to provide the requested information. If our office does not receive this information the next business day you will be billed 100% of the standard rate for the services provided and any labs drawn will need to be repeated.

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