Financial Assistance

Application

Download Patient Financial Assistance Application

Application (PDF - English version)

Application (PDF - Spanish version)

After completing the application, you may drop off the form at the Cashier's office. You can also mail the application to:

Silver Cross Hospital
Patient Accounts Dept.
1900 Silver Cross Blvd.
New Lenox, IL 60451 

The application will be reviewed and you will be notified within 14 days.

Need Assistance?
Applications for assistance are available by contacting our Patients Accounts department at (815) 300-7087, Monday through Friday, 8 a.m. - 4:15 p.m. or by email at This email address is being protected from spambots. You need JavaScript enabled to view it. This e-mail address is being protected from spambots. You need JavaScript enabled to view it . After hours, leave a message with your contact information and we will send you an application. If at any time you wish to speak directly to a Financial Counselor, please call (815) 300-7596.