Financial Assistance "*" indicates required fields Thanks for using our Eligibility Checker for Financial Assistance! Please answer the following questions to see if you may be eligible for a discount on your Blanchard Valley Health System bills.Including yourself, how many people are in your immediate family?*“Family” is defined as the responsible party, the responsible party’s spouse (if applicable), and all of their natural or adoptive children under 18 who live in their home.Please enter a number from 1 to 10.What is your estimated gross MONTHLY household income?*This is current household monthly income before taxes.Please enter a number from 0 to 1000000.This field is hidden when viewing the formPhone # For Text (Optional)This field is hidden when viewing the formFamily AdditionalsThis field is hidden when viewing the formFamily Additional Total 5500This field is hidden when viewing the formYearly Rate 15650This field is hidden when viewing the formCalculated % FPLThis field is hidden when viewing the formAnnual IncomePhoneThis field is for validation purposes and should be left unchanged.
