There are several ways you can obtain an application for financial assistance.
- Download and print this assistance form.
- Ask the registration staff at any of our facilities for an application for assistance.
- For inpatient services, a Patient Financial Advocate can complete and submit an application. To contact a Patient Financial Advocate, call our Customer Service Department from 8 a.m. to 4:30 p.m, Monday through Friday at 1-800-477-4035.
All applications may be faxed to 419-824-3450, submitted in person, or mailed to:
ProMedica Central Business Office
Attention: Financial Assistance
2142 N. Cove Blvd.
Toledo, OH 43606