Thank you for choosing Connecticut Children's for your child's health care needs.
To apply for financial assistance, please submit the completed application and all supplemental information. Verification of income is required in order to process this application. Verification of income can include:
- Federal Tax Returns (1040) for the past year.
- W-2(s)
- One month worth of paycheck stubs (last 4 if paid weekly/Last 2 if paid bi-weekly)
- Letter of financial support from the person that is financially supporting you/your family.
- Proof of Unemployment Wages Letter
- Child Support/Alimony Statement
- Social Security/SSI Statement
Our Financial Counselors are available should you require assistance with the application process.
- Phone: 860-545-8086
- Text: 860-891-2726
- Fax: 860-545-9057
- Email: FinCounselors [at] connecticutchildrens.org
- Location: 282 Washington St. – 2C | Hartford, CT
- Business Hours: 8:00 AM - 4:30 PM Monday - Friday
Financial Assistance Application
Incomplete or fraudulent applications will be denied. In completing this financial statement, I hereby affirm that the submitted statements are correct and complete, and I give my consent for further verification by Connecticut Children’s and/or its representatives.
We will confirm receipt and notify you of next steps within 72 business hours.