Get Application - Kaiser Permanente

Filling out the Application - Kaiser Permanente online is an essential step for individuals seeking medical financial assistance. This guide provides a straightforward approach to ensure that users can complete the application efficiently and accurately.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to obtain the application form. This will allow you to open the form for editing and review.
2. Begin filling out your personal information, including your name, contact number, and medical record number. Ensure accuracy as this information is crucial for processing your application.
3. List the family members applying for medical financial assistance. Provide names, and include details for any additional household members as required.
4. Indicate your employment status. Answer questions regarding current employment and any rental property ownership by selecting 'Yes' or 'No'.
5. Detail your monthly gross income. Include various sources of income such as salary, alimony, business income, and any other relevant earnings.
6. List your monthly expenses, categorizing them into items such as mortgage/rent, taxes, insurance premiums, and other expenses. This will give a comprehensive view of your financial obligations.
7. Compile the required documents mentioned in the application instructions to avoid processing delays. These include copies of tax forms, bank statements, and pay stubs.
8. After completing the form, review all entries for accuracy. Confirm that all required fields are filled and that you have included supporting documents.
9. Submit your completed application by mailing it to the address provided or using the listed fax number. Retain a copy for your records.

We encourage you to complete your application online today to access the support you need.