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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.


*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.