Get Trulance Patient Assistance

Completing the Trulance Patient Assistance Program application online can be straightforward when following these guided steps. This assistance program is available for individuals who are uninsured or financially distressed, helping them access Trulance at no cost.

Follow the steps to complete your application successfully.

1. Click ‘Get Form’ button to obtain the Trulance Patient Assistance application form and open it in the designated editor.
2. Begin filling out Part 1: Application. Start with the Patient Information section by entering your first name, last name, date of birth, contact information, and preferred method and time of contact.
3. Next, provide your Insurance Information. Include details regarding your primary and secondary insurance, such as policy holder's name, relationship to you, and insurance ID numbers.
4. Complete the Additional Insurance Information section. Here, answer questions about veteran status and previous eligibility for Medicare or assistance programs.
5. Proceed to the Treating Physician Information section. Fill in your physician's first and last name, phone number, practice name, and address.
6. In the Financial Information section, indicate the number of people in your household and provide the total combined adjusted net income.
7. Select the proof of income documentation you will provide. Options include federal tax returns, Social Security awards letter, pay stubs, or proof of job termination/unemployment.
8. Move to Part 2: Release. Review the authorizations carefully, then provide your signature and the date to confirm your consent and understanding of the terms.
9. Once you have completed all fields and ensured all information is accurate, save your changes. You can then download, print, or share the completed form as required.

Start your application process online today for access to Trulance through the Patient Assistance Program.