Providers:

To get started, or for additional information, please contact our sales team toll free at: (855) 642-2400, Monday through Friday 5:00am to 5:00pm PST or via email at sales@healthfirstfinancial.com. Our operations center is located at 400 International Way Suite 220, Springfield, OR 97477.

Patients:

Just fill out the application below to get started. Once this form is completed and submitted, you'll be on your way to helping us meet your medical financing needs. If you need any assistance, please don't hesitate to contact one of our friendly customer service representatives toll free at: (888) 394-3133, Monday through Friday 5:00am to 5:00pm PST.

PATIENT INFORMATION

EMPLOYER INFORMATION

PROVIDER INFORMATION

If 21 or over, please ensure that you capture on this application all readily accessible income earned from sources such as personal income and, if applicable, spousal/domestic partner income. Income can include salary and hourly wages, bonuses, commissions, self-employment, social security, retirement pay, public assistance, disability, pension, interest, dividends, or rental income. If under 21, please only include income earned by the applicant.

Thank you for getting started with HealthFirst Financial. You have taken the first step to managing your healthcare needs.
We will reach out to your provider about financing,
and one of our representatives will contact you within 10 business days.

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