LETTER OF SUPPORT FOR INDIVIDUALS WITH NO INCOME
If you receive support (e.g. Food, Housing, Financial Support) from a family member or friend please, have the
person who provides support complete this letter for you to receive the sliding fee discount.
Supporter: If the person you are filling this form out for lives with you, we will need copies of your monthly income
for them to receive the discount.
THANK YOU FOR CHOOSING ACCELHEALTH!