Forms

As part of our commitment to transparency and financial assistance, this resource page makes our hospital's financial forms easily accessible.

If you need to speak with a financial counselor during your stay please call extension 5635, from your room phone. If you need assistance or have any questions once you have been discharged you can contact the business office directly at 661‑949‑5781 or 800‑403‑1857.

Financial Documents

Financial Assistance Application

You can download the financial assistance application in English or Spanish.

Plain Language Summary

AVMC will provide financial assistance to patients that may not have sufficient financial resources to pay for services. To view our Plain Language Summary, in English or Spanish.

Shoppable Services

AVMC provides a comprehensive Hospital Pricing List known as the ChargeMaster (machine-readable file). This file provides a list of standard charges for the items and services that we provide, in addition to hundreds of shoppable services as well as discounted cash prices.

Financial Assistance Policy

To view our Financial Assistance Policy, click here.