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Apply for Financial Assistance

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.

You may submit your completed applications the following ways:

  • Upload your documents via     
  • Fax: 360-729-3047
  • Email:
  • Mail: PeaceHealth, PO Box 748632, Los Angeles, CA 90074-8632
  • In person: Applications may be taken to your local PeaceHealth Provider (In response to COVID, please check with your local provider before attempting to drop off)

Be sure to keep a copy for yourself.