Agape Family Health Patient Resources
Download Patient forms
Coming soon
Downloadable patients forms coming soon!
Insurance & Fee Information
Agape Family Health believes that everyone is entitled to affordable health care. No one will be denied access to services due to inability to pay.
- AFH uses a sliding-fee scale based on proof of income and individual patient’s ability to pay.
- We can assist you in applying for Medicaid benefits, insurance, and reassign PCPs.
- We also accept payment from third-party payers such as Commercial Insurance, Health Maintenance Organizations (HMOs) with authorizations, Medicare & Medicaid.
Sliding Fee Program FAQ’S
AFH is a “Federally Qualified Health Center.” We offer a Sliding Fee Scale Program that reduces fees on services for qualified patients.
AFH offers a program that reduces fees charged to uninsured patients based on their income and family size. We base patient eligibility for this program on percentages of “Poverty Levels” determined annually by the federal government. Fees are determined either by a minimum fee or a percentage of the full charges. Insured patients may benefit from this plan as non-covered services may also be subject to a fee reduction.
Like every program, AFH has requirements. We acquire specific information from our patients prior to determining eligibility and establishing a sliding fee level based on the Federal Poverty Guideline Determinations are not made until the required documentation has been provided.
In order for you to qualify for our Sliding Fee Scale program, you must fill out an application and provide one (1) of the documents below.
- Pay stubs (most recent 4 weeks of income) or,
- Most recent Income Tax Return (attach Schedule C if self-employed) – Expires 04/15 of the following year or,
- Workers Compensation (most recent four weeks of income) or,
- Unemployment Compensation (most recent four weeks of income) or,
- Disability or SSI Benefits letter (permanent or temporary) or,
- Social Security Income or,
- Documents from local, state or Federal Agency or,
- Completed Employment Verification (for cash paid household members) or,
- Notarized letter of Support from family member (when none of the above is available) or a notarized letter stating you have no income or,
- Any type of documentation that serves the purpose as proof of income or financial status.
Agape Family Health Patient Portal
Schedule appointments, stay connected to your providers, and more online with the Agape Family Health Patient Portal! Contact your local Agape location for your login.
COVID-19 in Jacksonville Testing, Vaccines, & Information
While the spread of COVID-19 may seem to be trending down, high risk communities have been found to be of greater risk to infection. There is increasing evidence that some racial and ethnic minority groups are being disproportionately affected by COVID-19.
