Financial Assistance Application - Augusta Health 2026

1. Click ‘Get Form’ to open the Financial Assistance Application in the editor.
2. Begin by entering your household size in the designated field. This includes yourself, your spouse, and any dependent children under age 21 living at home.
3. Fill in your full legal name, Social Security number, and date of birth. Repeat this for your spouse if applicable.
4. Provide your mailing address, including city, state, zip code, and phone number.
5. List all dependent children under age 21. For each child, include their legal name, age, Social Security number, relationship to you, and date of birth.
6. Document your total income from the last three months. Ensure you attach proof of income as required; failure to do so may delay processing.
7. Review the certification section carefully. Sign and date it to confirm that all information provided is accurate.

Start filling out your application today using our platform for a seamless experience!