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Patient Financial Assistance
Financial Assistance Form

Who is eligible for Saint Alphonsus assistance?
All patients, regardless of race, creed, gender, age, or national origin, may apply for financial assistance from Saint Alphonsus either in advance of or after receiving covered services.

Eligibility is determined on an individual basis, taking into account factors such as family size, income, assets and insurance status. Prior to completing this form, please contact our financial assistance office at 208-367-2130 Monday through Friday from 8 a.m. to 4:30 p.m for an assessment of your qualifications.

Once you have completed the form, send it along with the supporting documentation to:
Saint Alphonsus Patient Accounts
PO Box 190930
Boise, ID 83719