Solvista Health Financial Assistance Application


Financial challenges or lack of health insurance should not prevent you from receiving care. At Solvista Health, we are committed to providing health care to our community regardless of the ability to pay. Our core community includes Fremont, Custer, Chaffee, and Lake Counties.

Solvista offers assistance through Self Pay, Sliding Fee, and flexible payment arrangements for community members needing care and:

- Do not have insurance

- Are underinsured

- Demonstrate acceptable financial need

If you do not have insurance, you are encouraged to apply to the Colorado Medicaid Program: Apply for Health First Colorado and Child Health Plan Plus | Colorado Department of Health Care Policy & Financing

The Colorado Health Insurance Marketplace also has several options for insurance: Connect for Health Colorado


If you are unable to afford your care, you are encouraged to apply to be considered for financial assistance. To start, you must complete this application, provide acceptable proof of income, and answer any follow-up questions from Solvista’s financial assistance counselor.

Solvista Health reviews applications in the order they are received. All information Solvista Health requests must be provided before any fee is reduced. Solvista Health does not discriminate based on an individual’s race, color, gender, national origin, disability, religion, or sexual orientation.


Solvista Health requires proof of income for all family members living in the household. Acceptable proof of income may include:

- Most recent Federal Income Tax Return (form 1040) with supporting W-2/1099

- Pay stubs supporting the most recent 60 days of employment for those working in the household;

- Employment verification letter from your employer stating income and payroll frequency;

- Most recent Social Security or Unemployment payment statement;

- Any other documentation that you believe will help make a decision, such as court-ordered alimony, bank statements, unearned income statements, asset lists, etc.

You can request mental health counseling independently if you are a minor client (age 12 to 18). If you are still living with your parents or another adult guardian, you can apply for the financial assistance program on your own and do not need to show household income, only income you earn independently.

Please provide complete and accurate information the first time you apply to help Solvista decide quickly.

An approved level of assistance is good for one (1) year unless financial circumstances change sooner.


After you submit your application, Solvista will review it, and you may be contacted for additional information. Solvista uses an established sliding fee scale to determine eligibility based on income and family size. If you have any questions, need assistance completing the application, or would like to submit documents electronically, please get in touch with Solvista’s financial assistance counselor via phone (719-276-5475) or email ( You may also mail documents to: Solvista Health Business Department, 3225 Independence Rd., Cañon City, CO, 81212. We will contact you when we make our decision.


If we deny your application, you can appeal our decision in writing to Solvista with more information. If you are from an area outside of our community, we may redirect you to a local provider in your area.

Begin your online application here - Financial Assistance Application

Alternatively, a paper application can be downloaded here - Paper Application

Sliding Fee Scale