Financial Assistance Forms

Get the Financial Assistance Forms You Need

Our Financial Assistance Application and Proof of Income instruction sheet are available to download in several languages.

Note that the application and instruction form in English are the most current forms. Updated translated forms will be available online shortly.

*Please submit completed financial assistance application forms using ONE of the following methods:

  • Mail to:
    PO BOX 5299
    Mail Stop: 1002-1-PFN
    Tacoma, WA 98415-0299
  • Email to: [email protected]
  • Fax to: 253-864-4017
  • Take a printed copy of your completed Financial Assistance Application to any of our main hospitals or medical centers' Admitting Desk, where a navigator will help you file it.