Financial Assistance

If your family income is below 400 percent of the Federal Poverty Income Guidelines, you may qualify for financial assistance. Catastrophic medical coverage is also available if you have high medical costs (exceeding 10 percent of your family income). Our Patient Financial Services (PFS) office can determine whether you are eligible once you provide:

Your completed Financial Assistance Form and supporting documents should be returned to the PFS office. The PFS staff may contact you to request additional information. If you need assistance completing the form, please call our office. Once the eligibility process is complete, we will mail you a Financial Assistance Notification letting you know whether, and to what extent, you are eligible for financial assistance.

Additional payment options are available for those who do not qualify for financial assistance.

  • Patient Financial Services
    3950 Civic Center Drive, Suite 200
    San Rafael, CA 94903
    1-415-925-7070
    Email Us
  • Phone Hours
    Monday – Friday:
    7:30 am – 4:30 pm
  • Office Hours
    Monday – Friday:
    7:30 am – 3:00 pm
  • Online Bill Payment