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    Financial Assistance Program

    Photo of a child and his mom at an examination

    Sutter Gould Medical Foundation has a financial assistance program for Sutter Gould patients who are uninsured and low income who may not be able to pay their bill.

    Patients who submit an application and are approved may be eligible for full or partial write-off of charges.

    The Sutter Gould Financial Assistance
    Program is designed to:

    To apply for financial assistance at Sutter Gould Medical Foundation:

    1. Please complete the Statement of Financial Condition (PDF 0.19Mb).
      Note: If you need assistance with this form, please call 877-351-4875
    2. Include the following:
      • Your two most recent paycheck stubs;
      • Your two most recent bank statements (all accounts);
      • Your most recent tax return.
    3. Mail the packet to:
      • Sutter Gould Medical Foundation
        P.O. BOX 22050
        Salt Lake City, UT 84122
      • Or FAX to: 801-575-1265

    Copies of our charity care application are also
    available by calling 877-351-4875.

    Your Confidentiality is Guaranteed

    Confidentiality of information and individual dignity will be maintained for all that seek charitable services. The handling of personal health information will meet all HIPAA requirements.


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