Harris Health System Financial Assistance Program Application
Welcome to the Financial Assistance Application for Harris Health Patients
Be sure you, your spouse and all children between 18 and 26 years old who live with you are available to sign this form before you begin the application. The Harris Health Financial Assistance Program is for patients living in Harris County. There is no cost to make a Harris Health Financial Assistance Application. Harris Health's Financial Assistance Program is not an insurance plan. Harris Health does not provide health insurance coverage under the Federal Health Insurance Marketplace Exchange.
Please see the Harris Health System Notice of Non-Discrimination
You must provide information about yourself, your household income, your Harris Health System Medical Record Number, and any changes you have had since your last Harris Health System enrollment.
This section allows you to send additional proof documents to Harris Health if you have recently filed an application. You will need your Harris Health Medical Record Number to upload additional documents.