Apply for Financial Assistance

Choose a language to download the application:

• English
• Spanish
• Russian
• Vietnamese
• Tagalog
• Chinese
• Punjabi
• Arabic
• Somali
• Ukrainian
• Korean
• Chuukese

Did you know you could sign up online?

Feel free to apply by going to My Peacehealth.

Need help?

You can send us questions via My PeaceHealth or by contacting a Customer Service Representatives at 877-202-3597.

You may submit your completed applications the following ways:

• Upload your documents via www.mypeacehealth.org     
• Fax: 360-729-3047
• Email: financialassistance@peacehealth.org
• Mail: PeaceHealth, PO Box 748632, Los Angeles, CA 90074-8632
• In person: Applications may be taken to your local PeaceHealth Provider (In response to COVID, please check with your local provider before attempting to drop off)

Be sure to keep a copy for yourself.