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Get an Application

For Patients

• Download application (PDF 99kb)
• Request an Application
  • Pick up a form at any SEARHC facility
  • Visit our contact page to request an application directly from Healing Hand
  • Request an application from Mt. Edgecumbe Hospital Social Services at 966-8517

For Healthcare Providers

• Download worksheet to apply for funds on your patients' behalf  (PDF 65kb)

PDF files require Acrobat Reader

Completing Your Application

Need assistance filling out your application? Contact Healing Hand for help.

Mail or fax the completed application to Mt. Edgececumbe Hospital Social Services.

• Mail: Mt Edgecumbe Hospital Social Services, Attention: Melonie Boord, 222 Tongass Dr., Sitka, AK 99835
• Fax: (907) 966-8698 (Attention: Melonie Boord)

 

Patient Information

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