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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.
Financial Assistance Application:
English
Arabic
Burmese
Chinese-Simplified
Chinese-Traditional
French
German
Italian
Khmer
Korean
Lao
Marshallese
Punjabi
Russian
Somali
Spanish
Tagalog
Ukrainian
Vietnamese
Proof of Income Instruction Sheet:
English
Arabic
Burmese
Chinese-Simplified
Chinese-Traditional
French
German
Italian
Khmer
Korean
Lao
Marshallese
Punjabi
Russian
Somali
Spanish
Tagalog
Ukrainian
Vietnamese
*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 - 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.
