Availability see if you qualify "*" indicates required fields EmailThis field is for validation purposes and should be left unchanged.Thanks for using our Eligibility Checker for Financial AssistancePlease answer the following 3 questions to see if you may be eligible for a discount on your Demo Hospital bills. Including yourself, how many people are in your immediate family?*Please enter a number from 1 to 10. What is your estimated gross MONTHLY household income?*Please enter a number from 0 to 1000000. Would you like more information about Financial Assistance and applying online emailed to you or sent to you via text?* Yes No Name* First Last Email* Include Phone # For Text (Optional) Thank you! We have all we need to determine if you may be eligible for Financial Assistance at Demo Hospital. Please click below to see your results.This field is hidden when viewing the formFamily AdditionalsThis field is hidden when viewing the formFamily Additional Total 5500This field is hidden when viewing the formYearly Rate 15650This field is hidden when viewing the formCalculated % FPLThis field is hidden when viewing the formAnnual Income ready to learn more about making financial assistance easy? let’s chat
