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Get Teva Cares Foundation Application Form
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How to fill out the Teva Cares Foundation Application Form online
The Teva Cares Foundation Application Form is an essential tool designed to assist individuals in obtaining prescription medications at no cost. This guide provides step-by-step instructions to help users navigate and complete the form successfully online.
Follow the steps to complete the application form online.
- Click the ‘Get Form’ button to access the Teva Cares Foundation Application Form and open it in your preferred online editor.
- Begin by filling out the Patient Information section. This includes entering the patient's full name, date of birth, mailing address, and contact information.
- Next, complete the Financial Information section. Indicate the number of people in your household and your total yearly income, as well as provide proof of income as required.
- Proceed to the Insurance Information section. Specify whether you have any insurance coverage and provide the relevant details for each policy, including insurance names and policy numbers.
- Read through the Consent section thoroughly. By signing, you confirm that the information provided is accurate. Make sure to provide the signature of the patient or legal guardian.
- If you are a physician filling out the application, complete the Physician Information and the Prescribing Information sections.
- Finally, save your changes. You can download, print, or share the completed form as needed.
Take the next step and complete the Teva Cares Foundation Application Form online today.
If you need assistance related to Ajovy, you can call the dedicated number for Teva Ajovy support. Trained representatives are available to help answer your questions and guide you through the process of obtaining medication. When you reach out, they can also assist you in filling out the Teva Cares Foundation Application Form.
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