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| You many be eligible for financial assistance under the terms and conditions that Hammond-Henry Hospital offers to qualified patients. For more information, please contact our Financial Counselor in the Patient Accounts Department at (309) 944-9120 or email financialcounselor@hammondhenry.com
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Financial Assistance Application
Please answer all questions with the proper answer, or a zero if the question does not apply to you. Complete both pages of the application, attach additional sheet if necessary. Incomplete applications cannot be considered for payment and will be returen to you. Submit your completed application with a copy of the federal tax return you filed for last year's income. We cannot pay on accounts, which have been referred to a collection agency.
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To view or print out an application or brochure, you will need a copy of Adobe's Acrobat Reader.
You may
download it FREE here.
A Financial Assistance Application or brochure can be downloaded by clicking on their title. Download time depends on your internet connection speed (i.e. dial-up, cable, DSL).
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