Financial Assistance Application - California
Download and Mail
Please download the paper form and mail it, and the required documents, to:
PH&S Regional Business Office
P.O. Box 4227
Portland, OR 97208-3395
If you have any questions, please call us at:
Mon.–Fri. 8 a.m.-5:30 p.m. PT
We will respond to your request via mail within 14 business days of receiving it along with all required documents.
Download a list of providers who do and do not participate in financial assistance determination. Choose the hospital where you received or plan to receive care.
NOTE: Providers that do not follow the hospital’s financial assistance policy may have their own financial assistance policies, so please contact the provider directly if you have any questions regarding their policies.