Appointment and Information Line:

330-375-2772

Visiting the Clinic

• Proof of identity (photo ID - e.g., driver's license, Ohio ID card)
  
  
• Proof of income if you are requesting sliding fee scale (current pay stubs [2] or most current 1040 form)
  
  
• Any legal documents which apply to your visit (e.g., court order, letter from probation officer)
  
  
• Shot records for anyone who will receive shots
  
  
• Insurance cards (Medicaid, private insurance, Medicaid HMO, Medicare, Medicare Advantage)
  
  
• Any forms needed for your employer or school related to your visit
  
  

  ***** If a child is to be brought to the clinic by someone other than the custodial parent, the parent should call before the appointment for instructions on what is required. 330-375-2772 *****

To save time at your clinic appointment, you can print your forms ahead of time, fill them out and bring them with you to your appointment.

Immunization Forms Packet
International Travel Forms Packet
TB History Form

Please plan for payment with either CASH or CHECK.  We do not yet accept credit/debit card payment.  We cannot make change for $50 and $100 bills.

Clinic Fees

Lab Fees

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SLIDING FEE SCALE PROGRAM
Clinical Health Services offers sliding scale fee programs to clients who have limited income and little or no insurance for several clinic programs and for the Counseling program.  Fees are based on income and how many people live in the home.  Client payments are based on a standard formula that uses the annual Federal Poverty Level standards.  You must bring proof of income (copy of most recent 1040 (tax) form or two recent pay stubs, or other documentation of income) each time you come for services to use this program.

For childhood vaccines, hypertension, sexually transmitted diseases, tuberculosis and prenatal clinic programs the program uses the most current Child and Family Health Services (CFHS) scale:

SCPH Sliding Fee Scale

For Alcohol and Drug Counseling programs, the program uses the most current Alcohol, Drug and Mental Health Board (ADM) scale:

Counseling Sliding Fee Scale

Programs not included in the Sliding Fee Scales are adult and childhood privately-purchased vaccines (including travel vaccines) and employer contracted services.