Get Xhale Program

The Xhale Program enrollment and consent form is essential for facilitating your participation in the program. This guide provides a comprehensive overview and detailed instructions on how to complete the form effectively and accurately.

Follow the steps to complete the Xhale Program enrollment form online.

1. Click ‘Get Form’ button to access the Xhale Program enrollment form and open it in your document editor.
2. In the 'Patient Information' section, accurately enter the patient's personal details, including first name, last name, date of birth, and contact numbers. Ensure that you specify the preferred communication methods.
3. Complete the 'Referring Physician' section by providing the physician’s name, specialty, and contact information. All fields must be filled out legibly.
4. In the 'Service Options' section, choose the appropriate treatment dosage and frequency, such as 150 mg s.c. every 4 weeks, or 300 mg s.c. every 2 weeks.
5. Provide any relevant patient history and dosing information, ensuring all required details are accurately reflected.
6. Review and sign the 'Patient Consent' section, acknowledging your understanding of the program and authorizing the disclosure of personal information.
7. After completing all sections, choose to save changes, download a copy, or print the form for your records. Ensure that you keep a copy for future reference.

Compete your forms online today to ensure prompt processing of the Xhale Program enrollment.