At Memorial Hospital, we take great pride in providing excellent, compassionate health care. We provide financial assistance to those patients unable to pay in full for needed health care services. We ask that each patient who wants to take advantage of our Patient Financial Assistance Program meet the following requirements.

  • All other third party resources for which you are or may be eligible must be exhausted. This includes insurance plans, liability insurance, lawsuit settlements, workers compensation process, probate distributions, etc.
  • Prior to submitting your PFAP application, please contact your County Human/Social Services Department or go online ( to qualify for any applicable government programs, including Affordable Healthcare Act. If you are denied please include a copy of this denial with your PFAP application.
  • The care you receive must be considered “essential health care”. Services considered “elective” will not be eligible for PFAP.
  • You must fall within our eligibility guidelines that include income, assets and expenses.
  • Resident of Lafayette County, Wisconsin for a minimum of 6 months prior to receiving medical services.

Download an Application

Memorial Hospital of Lafayette County