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Compassionate Care Program
Financial Aid

Applying for financial help through the Compassionate Care Program
Sisters of Mercy Urgent Care strives to provide high-quality, affordable healthcare to everyone in the communities we serve. As part of this mission, we've established the Compassionate Care Program to assist those who may not have enough money to pay for services. To determine your eligibility for this program, please complete the PDF application below and bring it and any supporting documents to any Sisters of Mercy Urgent Care location. If you are unable to print the documents, you may pick up an application at any Sisters of Mercy Urgent Care center.

Compassionate Care Application Guidelines
  • Income information must be provided for all income-producing family members in the immediate household.
  • Please provide proof of income using W2 forms, tax returns or current payroll stubs.
  • Submitting an application does not guarantee that assistance will be granted.
  • Submit a separate application for financial aid for each new visit. Approval for one visit does not guarantee aid for future visits.

Sisters of Mercy Urgent Care will:

  • Notify all applicants regarding the status of their Compassionate Care application.

Who is responsible for your bill?
The patient (or requesting adult, if the patient is a minor) is financially responsible for the cost of any healthcare services provided by Sisters of Mercy Urgent Care. Payment for all services provided is due at the time of service unless prior arrangements have been made. Sisters of Mercy Urgent Care is not a free clinic.

Bills may be paid by:

  • Cash
  • Check
  • Debit card
  • Credit card

Questions?
The Sisters of Mercy staff are happy to answer any questions you may have about the Compassionate Care Program. We may also be able to refer you to other agencies that provide financial assistance for healthcare. Please call us at 828-252-8957, Option 7.

Applications
In order to view and print these applications, you must have Adobe Reader installed on your computer. Click here to download it for free.

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This page was last modified on May 13, 2011.

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