This application is to receive discounted costs for Emergency Medical Services invoices received from service by the City of Tacoma Fire Department. For more information about this program, refer to the TFD EMS Financial Assistance Policy. Please note Financial Assistance is only available if all other resources available to the patient have been utilized, including private or public insurance, government programs, or any other third-party coverage.

This form takes about 15 minutes to complete, please be sure you have time to complete the full application as it cannot be saved. All four sections are required and must be completed.

All information you provide is used only for financial assistance consideration and will become part of your medical record with Tacoma Fire Department. This application is covered by the HIPAA Privacy Policy of our organization, which can be accessed here: TFD Privacy Notice.