Reduced Fee Application

Thank you for choosing Southwestern Mental Health Center for your needs. To ensure your application is processed promptly, please complete this form. Proof of household income is required. You must provide 3 most recent paystubs for any household members 18 years of age or older that work OR an income tax return from the previous year. If you are eligible for a reduced rate we will let you know the amount you will owe each appointment. REDUCED FEES ARE DUE AT THE TIME OF SERVICE.

If you have any questions, please call our Billing Department at 507-935-2099.