Name:
Email:
Phone:
Comments:
“A Patient Advocate will call you within 24 hours”
(866) 960-9497
Dial Toll-Free for Assistance
Services
These are what we can do for you:
1. Research the assistance programs and identify which ones you will qualify for.
2. Complete all of paperwork required and obtain a signed prescription from your physician.
3. Make contact with the drug companies on your behalf. We will explain your situation and ask them for assistance.
4. Keep you up to date on the status of your prescription drugs. We don’t want you “in the dark”.
5. Continue to work with the pharmaceutical companies and your doctor on an ongoing basis so that you will continue to receive your brand name medicine at no cost.


