Apply Online
If you are ready to apply, you can now complete your Financial Assistance Application online. Please review the required information prior to completing the form. Incomplete or inaccurate applications may result in a delay or denial of financial assistance.
Apply By Mail
The following information is required to assist us in determining your eligibility for financial assistance. Income for all persons 18 years or older is required and includes unmarried or household partners and their dependents. Incomplete or inaccurate applications may result in a delay or denial of financial assistance.
- A completed and signed financial assistance application
- A complete copy of your most recent Federal Income Tax Return. If you are not required to file, please call the IRS at 800-829-1049 to request a form 4506-T
- Proof of income, including but not limited to: wages, tips, pension, IRA or annuities, SSI, child support, alimony, food stamps, cash gifts, grant income, or any other form of earned income
Please do not send original documents, receipts, or supporting materials from the list above, as they will not be returned to you.
Send application via mail to:
St. Luke's Hospital
Attention: Financial Assistance Committee
232 S. Woods Mill Rd.
Chesterfield, MO 63017