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Welcome to the Financial Assistance Application for Harris Health Patients

If you have questions regarding eligibility and how to apply or renew, or obtain the status of your application, call the Eligibility Call Center at 713-566-6509.

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. If you are asked for money to fill out or approve your application, do not send any money. Please report these incidents to Harris Health's Compliance Hotline at 844-565-0621. 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.

New Application

I want to start a new application. -->

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.

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Send Documents

I want to send proof documents. -->

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.

Send Additional Proofs