Financial Assistance application - BayCare - baycare 2025

1. Click ‘Get Form’ to open the Financial Assistance application in the editor.
2. Begin by entering your Hospital Account # and Date of Service at the top of the form. This information is crucial for processing your application.
3. Fill in your personal details, including your name, date of birth, and social security number. Indicate if you are pregnant or disabled, and select your marital status.
4. Provide your address and contact information. Ensure that all details are accurate to avoid delays in processing.
5. List all household members along with their dates of birth and citizenship status. This section helps determine eligibility based on household income.
6. Document all sources of income for each household member over the past 12 months. Be thorough to ensure a complete review of your financial situation.
7. Sign and date the application at the bottom, ensuring it is witnessed as required. Remember, notarization is not necessary.

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