All Mercy Medical Center locations have the hospital financial assistance policy available upon request. You may get a hard copy of the hospital financial assistance policy from Mercy Patient Accounts by calling 330-489-1145. The hospital’s financial assistance policies are also available in the admitting office and emergency department at 1320 Mercy Dr. NW., Canton, OH 44708.

Translations of the plain language summary, financial assistance policy and application form are available, if needed.

Financial counselors are available in the admitting office Monday through Friday from 8 am to 4:30 pm.

Financial assistance is available by filling out the financial assistance application and speaking to a financial counselor, who will obtain information to see if the patient is eligible for insurance. The financial counselor will screen for the ability to meet the obligation and, if eligible, for free care or charity care at 100% or 50%.

Patients applying for financial assistance may not be charged more than the amount generally billed to patients with insurance for emergency or other medically necessary care.

Application for Financial Assistance

If you need help paying for your medical bills or the medical bills of a loved one, please download, print and complete a financial statement:

Application for Assistance (English Version)


Application for Assistance (Spanish Version)


Read Mercy’s full collection policy.

Return your completed form to:

Patient Financial Services
Mercy Medical Center
1320 Mercy Drive NW
Canton, OH 44708

If you have any questions, please call 330-489-1145 between 8 am and 4:25 pm, Monday through Friday.