Wellness Center Sliding Scale Adjustment Request Form

Streamline Your Wellness Center's Sliding Scale Fee Adjustments

Making wellness services accessible to everyone, regardless of income, is a core value for many fitness and wellness centers. If your center offers sliding scale pricing to support clients facing financial challenges, this Wellness Center Sliding Scale Adjustment Request Form helps you manage that process with professionalism and compassion.

Why this form matters for wellness centers

This template is designed specifically for gyms, yoga studios, therapy centers, and holistic wellness facilities that want to:

• Process adjustment requests efficiently when clients experience income changes
• Calculate fair, consistent rates based on documented financial circumstances
• Set clear effective dates and recertification schedules to keep your records current
• Maintain dignity and privacy while gathering necessary income verification

Instead of handling sliding scale requests through email chains or paper forms that get lost, this Paperform template gives you a professional, secure way to collect sensitive financial information, calculate adjusted rates automatically, and trigger the right follow-up workflows.

How Paperform makes sliding scale management easier

With Paperform's conditional logic, you can show different documentation requirements based on income ranges or household size. Use calculation fields to automatically determine the new rate tier based on the client's reported income—no manual math or spreadsheet lookups required.

Once submitted, connect this form to Stepper (stepper.io) to automate your approval workflow: route requests to your billing team, update your membership management system, send personalized approval emails with the new rate and effective date, and schedule annual recertification reminders so no one falls through the cracks.

For wellness centers managing multiple locations or client segments, Paperform's native integrations with CRMs, spreadsheets, and billing tools keep everything synced. And because financial information is sensitive, you can trust Paperform's SOC 2 Type II compliance and secure data handling to protect your clients' privacy.

Built for compassionate, professional service

This form balances the need for documentation with a respectful, human-centered approach. It's designed for wellness professionals who want to make their services accessible while maintaining financial sustainability—whether you're a small yoga studio, a community fitness center, or a growing wellness brand.

Start with this template, customize the income tiers and rate structure to match your sliding scale policy, and create a smoother experience for both your team and the clients you serve.