Financial Assistance Application
You may be able to receive free or discounted care by completing financial assistance application.
- DMH Financial Assistance Application Form – Fillable
- DMH Financial Assistance Application for Web
- DMH Financial Assistance Application in Spanish
- DMH Financial Assistance Application in French
Please return completed application and supporting documents by mail, electronic mail or hand deliver to:
Decatur Memorial Hospital
Attention: Business Office
2300 North Edward Street
Decatur, Illinois 62526
email: DMHFinancialAssistance@mhsil.com
fax: 217-876-2281