Novel coronavirus (COVID-19) information for patients and visitors.

Financial Assistance Application

Choose a language to download the application:

Did you know you could sign up online?

Feel free to apply by going to My Peacehealth

Need help?

You can send us questions via My PeaceHealth or by contacting a Customer Service Representatives at 877-202-3597.

Sending in your completed application?

You can fax, email, or mail your completed applications to:

Fax:

360-729-3047

Email:

financialassistance@peacehealth.org

Mail:

PeaceHealth
PO Box 748632
Los Angeles, CA 90074-8632

In person:

Applications may be taken to your local PeaceHealth Provider or Hospital. 

Be sure to keep a copy for yourself.