Danville Counseling Center offers a Sliding Scale Fee Discount Program to assist clients with paying for therapeutic services. This program has specific criteria for enrollment through verification. The information obtained for verification will need to be updated annually. We cannot provide a discount without a completed application and income verification. 

All information within the Enrollment Application is kept confidential between you (the client and/or guardian) and the staff at Danville Counseling Center. No one will know the information unless a release of information is completed. 

How do I apply for the Sliding Scale Fee Discount Program? 

Individuals interested in applying for the discount may complete the Enrollment Application and bring it, along with proof of income, to their appointment. The individual should give the form and proof of income (last two paystubs if employed or three months of income documentation if self-employed) to Danville Counseling Center office staff so that the individual can meet the requirements before their visit with the provider.  

Sliding scale application and all supporting documents must be submitted to the office before a sliding scale rate will be approved. If all documents are not provided promptly the self-pay rate of $160 will apply to services rendered, payment is due at time of service. 

The attendance policy still applies to clients seen under the sliding scale policy. 24-hour notice must be provided to the office or clinician or the late cancelation/no show fee of $50 or the full session fee (if less than $50) applies, after 3 missed appointments clients are discharged with the option to return to the waiting list. A new application for sliding scale must be submitted if a discharge from services occurs.  

The following forms must be signed, dated, and completed before the first appointment: 

• Acknowledgement of Sliding Scale Fee Discount Program (this form) 
• Enrollment Application (provided separately) 

The Sliding Scale Fee Discount Program is based on family income, not necessarily household income. To receive the discount, you will need to provide verification of income. Fees are set based on the sliding scale fee schedule provided based on the national poverty guidelines. If you fall below 100% we charge a nominal fee of $20 per session. No client will be turned away due to inability to pay for services, the nominal fee is not a threshold for receiving services and thus not a minimum fee or co-pay. If waiving of services is needed this will be determined on a case-by-case basis and must be approved by a member of management.    

a. Family is defined as: a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family. Danville Counseling Center will also accept non-related household members when calculating family size.  

b. Income includes: gross wages; salaries; tips; income from business and selfemployment; unemployment compensation; workers' compensation; Social Security; Supplemental Security Income; veterans' payments; survivor benefits; pension or retirement income; interest; dividends; royalties; income from rental properties, estates, and trusts; alimony; child support; assistance from outside the household; and other miscellaneous sources. 

Danville Counseling Center accepts the following documents as proof of income: 

• 2 most recent paycheck stubs, W2, or form 4506-T 
• Letter from Social Security/Disability 
• Long Form from Food Stamp Office 
• Copy of Check/Bank Statement to Verify Child Support Payments 
• Other documents may work, but please ask office staff about specific requirements 

What kind of discount would I receive? 

The discount level is based on the income and number of family members in the household; specific rates can be found on the sliding scale fee schedule attached to this form. To retain discounted services this application must be completed annually.  

For your convenience, we do accept cash, checks, and debit/credit cards. 

Click here to view our fee schedule.