You May Qualify for a Lower-Cost Appointment

We understand that healthcare costs can be overwhelming — especially when high deductibles stand in the way of care. If you previously scheduled an appointment but were unable to continue due to cost, we may be able to help.

We’re offering an updated appointment option for families experiencing financial hardship. To see if this applies to you, please complete the form below.

By submitting this form, you’re letting us know that cost was a barrier to care — and giving us consent to provide you with adjusted options for scheduling. Your privacy and dignity are important to us. All submissions are reviewed securely and respectfully.

Financial Hardship Request

If you previously had to cancel an appointment with As You Are due to cost concerns, we may have a new path forward. Complete the form below to acknowledge financial hardship. After submitting this form, you will be redirected to your options and next steps.

"*" indicates required fields

Guardian Name*

First Last

Email*

Phone*

Child's Name*

First Last

Child's Date of Birth*

Privacy Notice & Electronic Acknowledgment:

By submitting this form, you confirm that the information provided is accurate to the best of your knowledge. Your acknowledgment of financial hardship will be reviewed solely for the purpose of assessing your eligibility for updated appointment options.

Submission of this form does not guarantee a change in cost or coverage, and does not constitute medical, legal, or financial advice. All determinations are made at the discretion of our clinical and administrative teams, in accordance with applicable laws and insurance requirements.

Your information will be handled in accordance with our Privacy Policy and is protected under HIPAA and relevant data protection laws.

We accept many major insurance plans. However, participation may vary by state and each child’s health insurance benefits.

We work with commercial insurance plans, TRICARE, traditional state Medicaid plans and managed care partners. We are constantly expanding our relationships as we grow. And, as a part of our process, our support team will review a child’s insurance benefits with their parent or guardian before the first appointment.