Self-Attestation Form

Transformation Healthcare Inc. (THI) offers a Sliding Fee Discount Program to support access to services based on household size and income. Applicants must provide proof of income within five (5) business days, and eligibility may be re-evaluated periodically or upon any change in financial status. All information is subject to verification, and approved discounts apply only to eligible services moving forward from the date of determination. Any false or incomplete information may result in removal from the program and adjustment of account balances.