Please tell us who will be submitting this application.
Patient / Applicant
If you are submitting your own application and you are not at your healthcare provider's office, please click the button below.
Healthcare Provider for a Patient
If you are a healthcare provider submitting an application on behalf of a patient, please click the button below. Note: If you are the Applicant applying at the Providers office, this is the correct button to click on. PLEASE NOTE: You will need your Finance Your Care Provider ID when applying here. If you do not have it, please call (844) 995-4657