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Complete an application for hospital debt relief

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Are you curious if you might qualify for Debt Dismissal?

60% of Americans Are Eligible for Medical Debt Relief.

Ready to apply? Watch how easy it is here!

We walk you through every step of the process, so you know exactly what to expect.

Application Checklist

Please have a copy of the following items prior to begining your online application

  • Debt Dismissal Employer Code
  • Pay Stubs from the Last two Months
  • Bank Statements from the Last Two Months
  • Last Year’s W2
  • Last Year’s Tax Return
  • Health Insurance Cards, if Applicable
Application Checklist