Use our upload tool to easily submit application documents on your patient’s behalf, including income, medical statements, and insurance cards.
Patient Demographic Information (address, date of birth, phone number, etc.)
Health Insurance Details
Estimated Household Income and Dependents
Supporting Income Documentation
Medical Statement to Confirm Diagnosis
Health Insurance Cards
Social Security Number or Alien ID
PSI offers financial support for a variety of chronic illnesses. View our current list of disease funds available to the patient community.