Financial Assistance

Financial assistance for patients in need.

Our financial assistance program available to patients who are unable to pay for medical care. Affinity Health System offers financial assistance to patients in Northeast Wisconsin because we believe all patients deserve high-quality health care, regardless of race, creed, color, gender, national origin, age, sexual orientation, handicap or ability to pay.

Through the financial assistance program, Affinity will cover part of your medical care costs. We will also help you make payment arrangements to cover the rest of your costs. To locate a copy of the financial assistance application please select a version to print from this site:


Our staff will talk with you about the eligibility requirements for financial assistance at any point before, during or after your treatment. Representatives are available from 8 a.m. to 4:30 p.m., Monday through Friday.

Application Process

The application process starts with a meeting with one of our representatives. During the meeting, you will complete a financial statement and application. This information determines the amount of financial assistance, if any, you may receive. By signing the application, you authorize Affinity to check the information you give us for accuracy.


We provide results as quickly as possible after you complete the application. If we deny your request, you may make a written appeal to the Patient Grievance Panel, which includes a community member. They will review your request.


For Affinity Medical Group, St. Elizabeth Hospital, or Mercy Medical Center, call (920) 738-2027, (920) 727-8065 or (920) 223-0484.
For Calumet Medical Center, call (920) 738-2027.

Contact Us

1506 S. Oneida St
Appleton, WI 54915
(920) 738-2000

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