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.
- Complete and signed financial assistance application
- A complete copy of your most recent Federal Income Tax Return. If you are not required to file a tax return, 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 income earned
Please do not send original receipts or proof of items above as they will not be mailed back.
If you have any questions, please call our Customer Service Department at 314-576-8100 or toll free at 888-924-9200, Monday - Friday 8:30 A.M. - 5:00 P.M. Please send the information to:
St. Luke's Hospital
Attention: Financial Assistance Committee
232. S. Woods Mill Rd.
Chesterfield, MO 63017
Download the Financial Assistance Application (PDF)