Demo Hospital Application
You must be a registered patient at DEMO Health System to apply. This is a TEST Site for demo purposes only, DO NOT ENTER ANY REAL PATIENT INFORMATION OR PROTECTED HEALTH INFORMATION
Click the Apply Here button below to access the Online Demo Financial Assistance Program application. You must also submit all required proof documents within 30 days in order to be considered for Financial Assistance. You may call 555-666-7777 and press option 1 to speak to a Financial Counselor if you have questions or need additional assistance.
New Application
Please click Apply below to begin your application for Financial Assistance.
Send Documents
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.