Renew Parkland Financial Assistance

Parkland has a NEW way to review your case if your eligibility for Parkland Financial Assistance will end in the next 30 days or if it has already ended in the past 6 months. To find out if you can keep getting benefits, a face-to-face interview is not required.

Please follow these steps to re-apply for Parkland Financial Assistance – no appointment needed!

1. Fill out the renewal form. Note any changes in where you live, where you get your mail, telephone number, email address, and family size. List all income (money you get) and fill out the self-employment income form if you are self-employed.
2. Sign and date the form.
3. Return the completed form and copies of proof of all income received in the last 30 days. You can return the form and proof in any of the following ways:
   • By Mail:
     Patient Financial Assistance Application
     Patient Financial Services
     5200 Harry Hines Blvd.
     Dallas, TX 75235
   • Online: Go to Parkland MyChart (Be sure to submit the application and upload proofs)
   • In Person: Bring your renewal form and proof of income to a financial counselor. Counselors are conveniently located at Parkland clinics throughout Dallas County.
4. If you have Medicare and are applying for Parkland Financial Assistance, please complete the asset form.

After reviewing the completed form and proofs, we will contact you if we need more information.

To learn more about co-pays and the cost of your healthcare services while enrolled in Parkland Financial Assistance, please review the patient payment responsibility chart or the patient payment responsibility chart (Spanish).

Patient Financial Assistance