Apply for Financial Assistance: Northern California
Download and Mail
Mail completed application with all documentation to:
Santa Rosa Memorial Hospital
Attn: Financial Assistance
P.O. Box 4119
Santa Rosa, CA 95402
Be sure to keep a copy for yourself.
To submit your completed application in person: Take to the Business Office.
We will notify you of the final determination of eligibility and appeal rights, if applicable, within 30 days of receiving a complete financial assistance application, including documentation of income.
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.