Speech-Language-Hearing Clinic Financial Assistance

The Speech Financial Assistance Application is a program designed to provide reduced fees based on a household's size and income. In order to be eligible for this program the following application must be signed, dated, and submitted to the clinic office.

This application must include (have scanned copies ready to upload to application):

Your family's most recent Federal Income Tax forms (1040-1040 EZ)
- If you are not required by law to file taxes please submit a letter stating that.
If you are reporting a change in income, proof of income must be included. Acceptable proof of income includes:
- Copy of paycheck stubs, Social Security or disability check stubs
- Employer verification letter of cash wages (must include employer name, address and phone number)

For OSU Affiliated Clients:

For semester rates for student, staff or faculty, you only need to fill out first section and sign the bottom of the form. Please check with clinic staff for OSU semester rates for student, staff or faculty.
If you are applying for a Sliding Scale Discount instead of the Semester Rate, you must complete application in full.

Click to Complete Financial Assistance Application

Clinic administration will review your application upon receipt. You will be notified of any approved discount once a determination is made. If you have any questions regarding this application, please call us at 405-744-6021.

See sliding fee schedule below for discount information.

Sliding Fee Schedule

First Row Discount Percentage, Second Row Amount Paid Per Session
Family Size	Nominal Fee $5 per visit	90% $6.50 per visit	80% $13 per visit	70% $19.50 per visit	60% $26 per visit	50% $32.50 per visit	40% $39 per visit	30% $45.50 per visit	20% $52 per visit	10% $58.50 per visit	0% $65 per visit
1	$15,060	$16,429	$17,798	$19,167	$20,536	$21,905	$23.274	$24,643	$26,012	$27,381	$28,750+
2	$20,440	$22,298	$24,156	$26,014	$27,872	$29,730	$31,588	$33,446	$35,304	$37,162	$39,020+
3	$25,820	$28,167	$30,514	$32,861	$35,208	$37,555	$39,902	$42,249	$44,596	$46,943	$49,290+
4	$31,200	$34,036	$36,872	$39,708	$42,544	$45,380	$48,216	$51,052	$53,888	$56,724	$59,560+
5	$36,580	$39,905	$43,230	$46,555	$49,880	$53,205	$56,530	$59,855	$63,180	$66,505	$69,830+
6	$41,960	$45,774	$49,588	$53,402	$57,216	$61,030	$64,844	$68,658	$72,472	$76,286	$80,100+
7	$47,340	$51,644	$55,948	$60,252	$64,556	$68,860	$73,164	$77,468	$81,772	$86,076	$90,380+
8	$52,720	$57,516	$62,306	$67,099	$71,892	$76,685	$81,478	$86,271	$91,064	$95,857	$100,650+

Based on 2024 Federal Poverty Guidelines

+For families/households with more than 8 persons, add $5,380 for each additional person.