Packard Pediatric Weight Control Program Financial Assistance
Families requesting financial assistance are required to complete a financial assistance application. The Patient Financial Advocacy Department will conduct a confidential review of the information provided to determine if the family qualifies for financial assistance for up to 100% of the charges.
The total program fees will be reduced for families who qualify for partial assistance. Families who receive partial assistance will be required to pay the remaining amount in full prior to the start of program.
Families who qualify for full assistance will receive 100% coverage of the total fees. These families are required to make a deposit prior to their first session. They will receive a full refund of their deposit by regularly attending and completing the PPWCP.
Completing the ApplicationPlease provide all requested information to the best of your ability when completing the financial assistance application (PDF) (en español). If you are unable to complete any sections of the application, please explain why in the “comments” section.
The information below must be included with your application:
- Name of the parent(s) or custodian as the legal guardian
- When applicable, list the spouse/domestic partner of the applicant as the other legal guardian
- Provide copies of the applicant and co-applicant’s:
- Two most recent pay stubs
- Last year’s W2 form or tax return form
Please include this information with your application OR include an explanation of why the information is missing. Providing one of these will prevent:
- Delays in processing your application
- Denials for your request for financial aid
Patient Financial Assistance
4700 Bohannon Drive 2nd Floor
Menlo Park, CA 94025
Phone: (650) 498-5816
Fax: (650) 498-6764