Family Health West knows that paying for medical care can be difficult for many families. As part of Family Health West Hospital’s commitment to our patients, we provide counseling and assistance to help individuals apply for available programs that may help cover unpaid hospital bills.
If you would like to apply for financial assistance, complete the application below. This application is also available from the Hospital Registration Department or from a Financial Counselor. Complete the form and return it as soon as possible.
Completing the application is not a guarantee that you will be approved for financial aid. We will review the details of your application which include current income, expenses, and family size. Be sure to sign the application, provide copies of the required documentation, and submit the application soon. You will be notified of our decision, in writing, within 30 days of receipt of the completed application.
The collection process will continue until your financial aid status is determined. Please make arrangements with our Financial Counselor as soon as possible.