Financial Assistance Forms

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Forms you need to apply for financial assistance

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:
P.O. Box 5299
Mail Stop: 1002-1-PFN
Tacoma, WA 98415-0299
Fax to: 253-864-4017
Email to: [email protected]
Online via MyChart (Please note: MyChart is currently not available for MultiCare Yakima Memorial Hospital)
In person. Take a printed copy of your completed financial assistance application to any of our main hospitals or medical centers’ Admitting Desk, where a financial navigator will help you file it.

More resources

Payment Plan

Learn more about interest-free, long-term and affordable patient financing.

Estimate Your Costs

There are several ways to get more information on treatment and procedure costs.

Understand Your Bill

View our walkthrough to help you understand your billing statements.

Contact Us

If you have billing questions, we are available to help Monday – Friday, 7:30am – 5pm. Please call 800-919-1936.

To reach a patient financial navigator, call 833-936-0515.