Apply Now

To apply, you will need:

  • Patient Demographic Information (address, date of birth, phone number, etc.)
  • Health Insurance Details
  • Estimated Household Income and Dependents

Once we receive your application, we may need:

  • Supporting Income Documentation
  • Medical Statement to Confirm Diagnosis

Apply For Assistance


Interested in receiving PSI assistance, click here, to see if you may qualify for one of our Programs. 

Already have a Patient Account?

Already have a Patient Account with PSI?  Login into your Patient Portal to apply.

Apply Now

Applying for PSI assistance is easy. Apply today through our user-friendly application.

A non-profit 501 (C ) (3) Patient Assistance Organization

Hours of Operation

8:30AM-5:00PM EST M/T/TH/F
9:30AM-5:00PM EST Wed
Closed from 12:30-1:30PM EST

Contact Us

Patient Services, Inc.
P.O. Box 5930
Midlothian, VA 23112
Fax: 1-804-744-9388

Phone: 1-800-366-7741