Get To Download The Vanda Patient Assistance Program Enrollment Form

Filling out the Vanda Patient Assistance Program Enrollment Form online is an essential step for patients seeking assistance with their medical needs. This guide provides a comprehensive and supportive approach to ensure that users can successfully complete the form with all necessary details.

Follow the steps to complete the enrollment form online

1. Click the ‘Get Form’ button to access the enrollment form, which will open in your chosen digital editor.
2. Begin by reviewing the eligibility criteria that include being a US resident, meeting income requirements, and having no prescription coverage.
3. The Health Care Professional (HCP) must complete and sign the Prescriber Form, located on page 2 of the enrollment application.
4. Next, the patient should fill out and sign the Patient Form, which spans pages 3-4. Ensure all required personal and financial details are accurately documented.
5. The patient needs to attach copies of all required financial documentation, including the most recent year’s tax returns.
6. Once both forms are fully completed, submit the documents along with the financial paperwork. They can be sent via mail or fax to the provided contact details.
7. If you choose to fax the application, be sure to include a cover sheet and ensure it is sent from the HCP’s office.
8. After submission, the Vanda Patient Assistance Program will review the application. Patients will receive a notification regarding their application status shortly thereafter.
9. Do not forget to save any changes, and if necessary, download or print a copy of the completed form for your records.

Take the first step toward enrolling in the Vanda Patient Assistance Program by completing the form online today.