Apply For Financial Assistance.

We'll need to understand and verify your current financial situation, and that begins by completing our Financial Assistance Application.

Rest assured, we take extraordinary care to protect your confidential mental and financial information. We never rent, lease, or sell your protected health information.

See if you qualify for financial assistance.

Sample Completed Financial Assistance Application.

Click here to view a completed financial assistance form.

Currently, assistance is available only to US residents in limited service areas.