Get The Safety Net Foundation Application

The Safety Net Foundation provides valuable assistance to qualifying patients by offering access to Amgen medicines free of charge. This guide offers a comprehensive overview to help individuals successfully complete the application online, ensuring that you provide all necessary information clearly and accurately.

Follow the steps to successfully complete your application

1. Click the ‘Get Form’ button to obtain the application form and open it in your preferred editor.
2. Begin with the Patient Information section. Provide your full name, date of birth, and contact information including your mailing address and social security number. Ensure that all fields marked as mandatory are completed.
3. Indicate your current adjusted gross household income, along with the total number of people living in your household, including yourself, and answer residency questions to confirm your eligibility.
4. If you have insurance, obtain and enter your diagnosis code from your physician as required in the appropriate field.
5. Complete the Patient Certification and Authorization to Disclose Information, ensuring that you understand and acknowledge the terms stated before signing.
6. Fill out the Product Information section by answering all questions related to the specific Amgen product you are requesting.
7. Complete the Physician and Facility Information section to provide necessary details about your healthcare provider and their contact information.
8. Review the entire application for completeness and accuracy to prevent any delays in processing time.
9. Once finished, you can save your changes, download, print, or share the completed application as needed.

Start your application process online today for assistance with accessing Amgen medicines.