There are several ways you can obtain an application for financial assistance.
- Download and print this assistance form.
- Ask the registration staff at any of our facilities for an application for assistance.
- For inpatient services, a Patient Financial Advocate can complete and submit an application. To contact a Patient Financial Advocate, call our Customer Service Department from 8 a.m. to 4:30 p.m, Monday through Friday at 1-844-373-0871.
All applications may be emailed to firstname.lastname@example.org, submitted in person, or mailed to:
ProMedica Financial Services
300 N. Summit Street
Toledo, OH 43604