Multicare Financial Aid Form. Apply for financial assistance today. Plus, we make it easy for you to connect with the care you need with convenient appointment scheduling options for both new and existing patients.
FREE 6+ Financial Aid Forms in PDF Ms Word
Please submit completed financial assistance application forms using. Your signed, completed form can then be sent to us via: Web patients may apply for financial assistance by submitting a financial assistance application with income information. Request for restriction of personal health information. You must provide information on your family’s income. If you cannot pay your bill, we may be able to help you with our financial assistance plans. If you qualify, you may then apply for financial assistance. With multiple locations across washington state, we’re here for you when — and where — you need us. Multicare uses the federal poverty guidelines to help determine what financial assistance program best fits your needs. Our financial assistance application and proof of income instruction sheet are available to download in several languages:
Web if we cannot reasonably grant your request, we will send you a letter advising you of multicare’s decision. With multiple locations across washington state, we’re here for you when — and where — you need us. Web online scheduling now at multicare. Apply for financial assistance today. Request for restriction of personal health information. Start by filling out this application. You must include proof of income with your application. Multicare is a nonprofit health system. Your signed, completed form can then be sent to us via: Plus, we make it easy for you to connect with the care you need with convenient appointment scheduling options for both new and existing patients. If you cannot pay your bill, we may be able to help you with our financial assistance plans.
