As part of our commitment to serve our community, Perry Memorial Hospital has elected to offer financial assistance to individuals who meet certain income requirements. Household income, family size, assets, and financial information will be compared against the current Federal Poverty Guidelines (FPG) in effect at the time of application. Financial assistance will be provided to those patients and/or guarantors who do not have the financial ability to pay all or part of their hospital bill. Financial assistance will not be granted until an application is completed and approved and it is the responsibility of the patient and/or guarantor to submit a complete application for financial assistance.
Financial Assistance Application
Use the link above to access the PDF fillable application.
Once you have the form completed, please print and either mail or bring to:
Perry Memorial Hospital
Attn: Business Office
501 N 14th St
Perry OK 73077
If you have any questions about financial assistance or filling out the application, our PMH Financial Counselors are happy to assist you by calling 580-336-2176 ext. 3262 or ext. 3272.