Follow the steps to complete your financial assistance application

1. Press the ‘Get Form’ button to access the financial assistance application form and open it for editing.
2. Begin by providing your personal details in the designated fields. This includes entering your full name, social security number, and mailing address. Ensure all information is accurate to avoid delays in processing.
3. Gather and upload the necessary documentation required for your application. This includes three months of checking statements, three months of pay stubs and W-2 forms, and any relevant medical expenses incurred in the past three months.
4. In the ‘Dependents in Household’ section, list the names, ages, dates of birth, and social security numbers of all dependents, including your spouse and children under 18.
5. Complete the employment section by providing the employer’s name and your current gross income. Include details for both yourself and your spouse, if applicable.
6. Fill in the ‘Other Income’ section, providing information about any additional income sources such as social security, pensions, unemployment benefits, and rental income.
7. Detail your monthly expenses, including child support, medical expenses, and pharmacy costs. Be truthful and precise in reporting this information.
8. Review the certification statement and confirm that all information provided is accurate. Your signature and the date should be added at the bottom of the form.
9. After completing the form, save your changes. You may also wish to download, print, or share the completed application as needed.

Ready to begin? Complete your Thomas Hospital Financial Assistance application online today.