Financial Assistance "*" indicates required fields Thanks for using our Eligibility Checker for Financial Assistance! Please answer the following 3 questions to see if you may be eligible for a discount on your Fisher-Titus Medical Center bills.Including yourself, how many people are in your immediate family?*“Family” is defined as the responsible party, the responsible party’s spouse (if applicable), and all of their natural or adoptive children under 18 who live in their home.Please enter a number from 1 to 10.What is your estimated gross MONTHLY household income?*This is current household monthly income before taxes.Please enter a number from 0 to 1000000.Would you like more information about Financial Assistance and applying online emailed to you?* Yes No Name* First Last Email* HiddenPhone # For Text (Optional)HiddenFamily AdditionalsHiddenFamily Additional Total 5380HiddenYearly Rate 15060HiddenCalculated % FPLHiddenAnnual IncomePhoneThis field is for validation purposes and should be left unchanged.
