Sliding Fee Application
	Click on the image to the right to fill out the the sliding fee application online. Once you have completed the application please mail your completed application and proof of income to the following address for review. If you prefer you can also fax your application and proof of income to (209) 754-6274, Attn: Billing. If you need any assistance or have any questions regarding this application, please contact our billing department during normal business hours at:    (209) 754-6240 or (866) 894-1902 You must have Adobe Reader 8.0 or higher installed in order to view the application online. To download the newest version of adobe click here....	MACT Health Board, Inc.   Attn: Billing Department   Po Box 939   Angels Camp, CA 95222-0939