Forms to Apply for Financial Assistance

First, download our financial assistance application and proof of income instruction sheet are available to download in several languages:

• English – Financial Assistance Application (PDF)
• Español – Spanish Financial Assistance Application (PDF)
• Русский – Russian Financial Assistance Application (PDF)
• Tiếng Việt – Vietnamese Financial Assistance Application (PDF)

Next, submit your completed financial assistance application form using one of the following methods:

• Online through MyChart
• Email: [email protected]
• Fax: 253-864-4017
• Mailing Address:
  P.O. Box 5299
  MS: 1002-1-PFN
  Tacoma, WA 98415-0299
• In person. Take a printed copy of your completed financial assistance application to any of our main hospitals or medical center Admitting Desk, where a financial navigator will help you file it.