Renew Parkland Financial Assistance

If your PFA plan is ending (or ended within the last 12 months) and your income and Dallas County residency status have not changed, you may be able to automatically renew your plan without a new application  Simply fill out and this Application/Renewal Clearance form and present it to a Parkland financial counselor, no appointment needed. 

If your income or residency has changed, please follow these steps to re-apply for Parkland Financial Assistance.

1. Fill out the application. (English | Spanish)  Note any changes in where you live, where you get your mail, telephone number, email address, and family size. List all income (money you get) and fill out the self-employment income form if you are self-employed.
2. Sign and date the form.
3. Return the completed form and copies of proof of all income received in the last 30 days. You can return the form and proof in any of the following ways:
   • By Mail:
     Patient Financial Assistance Application
     Patient Financial Services
     5200 Harry Hines Blvd.
     Dallas, TX 75235
   • Online: Reapply online HERE or through Parkland MyChart (Be sure to submit the application and upload proofs)
   • In Person: Bring your renewal form and proof of income to a financial counselor. Counselors are conveniently located at Parkland clinics throughout Dallas County.
4. Please complete the employment verification form. (English | Spanish)
5. If you have Medicare and are applying for Parkland Financial Assistance, please complete the asset form. (English | Spanish)

After reviewing the completed form and proofs, we will contact you if we need more information.

To learn more about co-pays and the cost of your healthcare services while enrolled in Parkland Financial Assistance, please review the patient payment responsibility chart. (English | Spanish)

Contact Patient Financial Services

214-590-8831
Monday – Friday
8 a.m. – 4:30 p.m.

Parkland Tower Garage
2021 Medical District Drive
Dallas, TX 75235

Parkland's financial counselors are conveniently located near the hospital and Parkland community health centers throughout Dallas County (English | Spanish).

Parkland provides translation services in 166 different languages.