Minor Services Financial Assistance Application | Norton Healthcare Louisville, Ky.

Minor Services Financial Assistance Application

* Asterisk indicates a required field.
  • INCOME INCLUDES: PATIENT INCOME, SPOUSE INCOME, CHILD SUPPORT/ALIMONY, MONTHLY SOCIAL SECURITY CHECKS, PENSION, UNEMPLOYMENT, SSI, DISABILITY. INCLUDES ANY OTHER INCOME.
  • Resources

  • EXCLUDES THE HOME YOU CURRENTLY RESIDE IN; INCLUDES ANY ADDITIONAL PROPERTY, LAND, RENTAL HOMES, ETC.
  • THIS CERTIFIES THAT I REQUEST TO BE CONSIDERED FOR FINANCIAL ASSISTANCE AT NORTON HEALTHCARE I HEREBY AGREE TO FURNISH NORTON HEALTHCARE WITH THE INFORMATION NECESSARY TO DETERMINE MY ELIGIBILITY FOR ASSISTANCE WITH THE MEDICAL BILLS RESULTING FROM THE SERVICES I HAVE RECEIVED AT THEIR FACILITIES. I UNDERSTAND THAT MY PHYSICIANS AND OTHER HEALTH CARE PROVIDERS MAY HAVE FINANCIAL ASSISTANCE POLICIES THAT COULD ASSIST ME WITH THE MEDICAL BILLS FROM THOSE PROVIDERS. AS SUCH, I AUTHORIZE NORTON HEALTHCARE TO PROVIDE A COPY OF MY APPLICATION TO THOSE PROVIDERS WHO REQUEST IT TO ASSIST THEM IN DETERMINING WHETHER I QUALIFY FOR BENEFITS UNDER THEIR FINANCIAL ASSISTANCE PROGRAMS. I CERTIFY THAT THE INFORMATION PROVIDED BY ME IN THIS APPLICATION IS CORRECT AND TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT IF I GIVE FALSE INFORMATION OR WITHHOLD INFORMATION IN APPLYING FOR ASSISTANCE, MY APPLICATION WILL BE DENIED AND NORTON HEALTHCARE WILL CONTINUE TO PURSUE COLLECTION OF ANY OUTSTANDING BALANCE DUE. IN THAT INSTANCE, I MAY ALSO BE SUBJECT TO PROSECUTION FOR FRAUD. I AGREE TO NOTIFY NORTON HEALTHCARE OF ANY CHANGES TO THE INFORMATION PROVIDED IN THIS FORM INCLUDING ADDRESS, TELEPHONE NUMBER, AND INCOME.
  • By checking here I certify that I have read and understand the above paragraphs, and that I request to be considered for financial assistance for hospital charges at Norton Healthcare.
Customer Service

Norton Healthcare
Customer Service

(502) 479-6300

Or toll-free

(800) 874-3979

COVID Vaccine

Schedule Your COVID-19 Vaccination

Appointments available for those eligible per state guidelines at select locations

Book Online


COVID-19 Rapid PCR Testing

Same-day appointments at a location near you

Book Online


(502) 861-4611, option 1

Norton Healthcare opens cutting-edge laboratory providing increased efficiency, quality and turnaround times, benefiting medical providers and patients

Norton Healthcare recently opened its relocated and expanded CPA Lab, a division of Norton Healthcare. Located in 46,000 square feet of space at the former Hikes Point Kmart site at 2935 Breckenridge Lane, the new […]

Read Full Story

I’m not the same person after my stroke

You wouldn’t look at Robert Taylor and think he survived a stroke. The 56-year-old is a poster child for good health. He ran the Boston Marathon, completed three Ironman competitions — including the national championship [...]

Read Full Story

Weight loss surgery for a medical professional

For some, the choice to have gastric sleeve surgery and then actually go through with it may be a monthslong or yearslong process. Not so for Devin Gehrke, R.N., clinical nurse educator at Norton Women’s […]

Read Full Story

Lauren Jones: The pain and loneliness of fighting COVID-19 locked away from family

I never thought it would pick me. Until it did. The elusive COVID-19 sneaked up on me like a killer in a horror movie, slowly tore apart my body, devoured my soul and left me […]

Read Full Story

Norton Children’s opens preregistration for COVID-19 vaccinations in children ages 12 and older

In anticipation of the U.S. Food and Drug Administration emergency use authorization for a COVID-19 vaccine for children ages 12 to 15, Norton Children’s has opened vaccine preregistration for children ages 12 and up on […]

Read Full Story
Related Stories

Norton Healthcare opens cutting-edge laboratory providing increased efficiency, quality and turnaround times, benefiting medical providers and patients

Norton Healthcare recently opened its relocated and expanded CPA Lab, a division of Norton Healthcare. Located in 46,000 square feet of space at the former Hikes Point Kmart site at 2935 Breckenridge Lane, the new […]

Read Full Story

I’m not the same person after my stroke

You wouldn’t look at Robert Taylor and think he survived a stroke. The 56-year-old is a poster child for good health. He ran the Boston Marathon, completed three Ironman competitions — including the national championship [...]

Read Full Story

Weight loss surgery for a medical professional

For some, the choice to have gastric sleeve surgery and then actually go through with it may be a monthslong or yearslong process. Not so for Devin Gehrke, R.N., clinical nurse educator at Norton Women’s […]

Read Full Story

Lauren Jones: The pain and loneliness of fighting COVID-19 locked away from family

I never thought it would pick me. Until it did. The elusive COVID-19 sneaked up on me like a killer in a horror movie, slowly tore apart my body, devoured my soul and left me […]

Read Full Story

Norton Children’s opens preregistration for COVID-19 vaccinations in children ages 12 and older

In anticipation of the U.S. Food and Drug Administration emergency use authorization for a COVID-19 vaccine for children ages 12 to 15, Norton Children’s has opened vaccine preregistration for children ages 12 and up on […]

Read Full Story

Search our entire site.

Schedule an Appointment

Select an appointment date and time from available spots listed below.