DEMO OF PARKLAND FINANCIAL ASSISTANCE APPLICATION

This is a TEST Site for demo purposes only, you are not actually applying to anything. DO NOT ENTER ANY REAL PATIENT INFORMATION OR PROTECTED HEALTH INFORMATION

This text would match your current instructions

New Application

Please click Apply below to begin your application for Financial Assistance. THIS IS A TEST SITE YOU ARE NOT APPLYING TO ANYTHING.

Send Documents

THIS WOULD BE THE SAME AS TODAY. If you have already filed an application and have been asked to submit new or additional proof documentation or forms, you may click the link below to send us additional proofs.