Please click the link below to download our Patient Financial Assistance Form. After filling out the application please either return it in person to 1616 S Pioneer Way, Moses Lake.
Fax it back to 509.764.3244
Or Mail It:
660 S. Coolidge Road
ATTN: Patient Financial Services
Moses Lake, WA 98837
If you have any questions regarding this form, please call 509.793.9715.