Financial Assistance Program
We know that medical bills many times are unexpected, and frequently unaffordable. Our financial assistance program is designed to help patients that have no, or limited insurance, with their bills. Financial assistance is based on income, assets, and other factors.
Please be aware that we frequently approve Financial Assistance prior to providing services as well as after services are rendered.
In order to make the application process easier and more accessible, we offer the application form in many languages.
To read PDF documents, you may need to download a free copy of Adobe Acrobat Reader
Application Forms & Guidelines
- Financial Aids Guidelines: English | Application Form: English [PDF]
- Application Form: Chinese [PDF] | Financial Aid Guidelines: Chinese
- Application Form: Hmong [PDF] | Financial Aid Guidelines: Hmong
- Application Form: Japanese [PDF] | Financial Aid Guidelines: Japanese
- Application Form: Russian [PDF] | Financial Aid Guidelines: Russian
- Financial Aids Guidelines: Spanish | Application Form: Spanish [PDF]
- Application Form: Tagalog [PDF] | Financial Aid Guidelines: Tagalog
- Application Form: Vietnamese [PDF] | Financial Aid Guidelines: Vietnamese
Important Billing Information for Patients
Uninsured patients are patients who have no health insurance or third-party payer source to assist with the payment of their hospital bill. The documents listed below is designed to help our uninsured patients understand our billing process, payment options, and services available.