Genentech: Apply for Help

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autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen></iframe> </div> </section> <section class="editorial"> <h3>How to Enroll in Genentech Patient Support Services and the Genentech Patient Foundation</h3> <p>This video walks you through the steps needed to enroll in the Genentech Patient Foundation and other Genentech patient support services.</p> <p><a class="callout-text__link" href="https://youtu.be/ivz3EB-5Om0" target="_blank"><span class="inner-text">WATCH THE VIDEO ON YOUTUBE</span></a></p> </section> <section class="editorial"> <div class="callout-text" style="text-align: center;"> <p><strong>Please Note:</strong> At this time, Genentech supports Cellcept through a separate process.</p> <p class="callout-text__body"><a class="callout-text__link" href="/patients/patient-foundation/other-support-programs"><span class="inner-text">Learn more about these support programs</span></a></p> </div> </section> </div> </div> </div> </div> <a name="hcp" id="hcp" class="js-scrolldepth-element anchor-block"></a> <div class="v4-constrained"> <div class="l-grid"> <div class="l-content-container l-content-container--no-min-height"> <div class="l-content"> <div class="spacer-block" style="--spacer-height: 20px;"></div> <header class="section-title "> <div class="section-title__main"> <h1 class="section-title__head">Health Care Providers</h1> <p>Health Care Providers can submit the completed Patient Consent and Prescriber Foundation form in two ways:</p> </div> </header> <section class="editorial"> <div class="block-basic" style="text-align: center;"> <div class="block-grid"> <div class="block-grid__cell"> <h3>Option 1: Submit forms online</h3> <p>If your practice has a registered account for My Patient Solutions, you can get started by logging into your account.</p> <p>Log into <a href="https://genentech-prod.force.com/ihcp/GNE_CM_PACT_Login#!/">My Patient Solutions</a>.</p> <h3>Don't have an account?</h3> <p><strong>Step 1:</strong> Ask your patient to complete the online Patient Consent Form, which is available in English and Spanish:<br /> <a href="https://genentech-pps.my.site.com/digitalconsent/s/?source=gene&preferredLanguage=en" target="_blank"><span class="inner-text">Patient Consent Form</span></a> | <a href="https://genentech-pps.my.site.com/digitalconsent/s/?source=gene&preferredLanguage=es" target="_blank">Formulario de Consentimiento del Paciente</a></p>  <p><strong>Step 2</strong>: Complete the online <a href="https://genentech-access.secure.force.com/enroll/">Prescriber Foundation Form</a>.</p> </div> <div class="block-grid__cell" style="border-left: 2px solid #dce1e3; padding-left: 20px;"> <h3>Option 2: Print forms and fax or text</h3> <p><strong>Step 1</strong>: Print the Patient Consent Form for your patient to complete, which is available in English and Spanish: <br /> <a href="https://www.genentech-access.com/content/dam/gene/accesssolutions/pdfs/patient-consent-form/Genentech-Access-Solutions-Patient-Consent_Form.pdf" target="_blank">Patient Consent Form</a> | <a href="https://www.genentech-access.com/content/dam/gene/accesssolutions/pdfs/patient-consent-form/Genentech-Access-Solutions-Patient-Consent-Form_Spanish.pdf" target="_blank">Formulario de Consentimiento del Paciente</a></p>  <p><strong>Step 2</strong>: Print and complete the <a href="/download/pdf/Genentech_Patient_Foundation_Prescriber_Foundation_Form.pdf">Prescriber Foundation Form</a>.</p> <p><strong>Step 3</strong>: Submit the completed forms via fax or text.</p> <p>Send via fax to <a href="tel:8339994363">833-999-4363</a></p> <p>Text a photo of the form to  <a href="tel:6508771111">650-877-1111</a></p> </div> </div> <p><strong><u>Both forms are required.</u></strong> No action can be taken until a completed Patient Consent Form and Prescriber Foundation Form have been received.</p> <p>The request will be processed within 5 business days upon receipt of both required forms and your office will be contacted to discuss the application outcome and any next steps</p> </div> </section> </div> </div> </div> </div> <a name="patients" id="patients" class="js-scrolldepth-element anchor-block"></a> <div class="v4-constrained"> <div class="l-grid"> <div class="l-content-container l-content-container--no-min-height"> <div class="l-content"> <header class="section-title section-title--no-spacer"> <div class="section-title__main"> <h1 class="section-title__head">Patients</h1> <p></p> </div> </header> <section class="editorial"> <div class="block-basic" style="text-align: center;"> <p><strong>Step 1:</strong> Complete the online Patient Consent Form, which is available in English and Spanish:<br /> <a href="https://mps-gene.force.com/digitalconsent/s/?source=gene&preferredLanguage=en"><span class="inner-text">Patient Consent Form</span></a> | <a href="https://mps-gene.force.com/digitalconsent/s/?source=gene&preferredLanguage=es" target="_blank">Formulario de Consentimiento del Paciente</a></p> <p><strong>Step 2:</strong> Once you have completed the Patient Consent form, you can inform your doctor's office and let them know that you are applying for assistance from the Genentech Patient Foundation.</p> <p>Your doctor will have to complete another form called the Prescriber Foundation Form. <strong><u>Both forms are required</u>. 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