Financial Assistance Application

If you do not have insurance, you can speak with one of our Customer Service Representatives about payment terms and financial assistance by calling 1 (866) 665-2636. We may be able to make payment plan arrangements and help you secure Medicaid, Supplemental Security Income (SSI) and other benefits for which you are eligible. We also offer other discounts that may be applicable to you your specific situation.

Financial Assistance Form

St. Vincent Healthcare

Download the Financial Assistance Application »

Please complete the financial assistance form, provide all supplemental information and mail your completed application to:

Financial Assistance
PFS SCL Health
500 Eldorado Blvd., Bldg. 6, Suite 6300,
Broomfield, CO 80021

Once we have received your completed application our Financial Counselors will review your application and will inform you of the decision or if any additional information is required.