COVID-19 Vaccine Updates
If you are currently eligible to receive the vaccine (Phase 1A or Phase 1B, tier 1) and need to get your first dose, please call our automated vaccine line at 833-770-0530 to add yourself to the wait list for a first-dose appointment and request updates. More information
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.
