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How to fill out the Teva Cares Form online
The Teva Cares Form is a crucial document designed to help individuals apply for prescription medications at no cost through the Teva Cares Foundation Patient Assistance Program. This guide provides a clear, step-by-step approach to filling out the form online, ensuring you complete it accurately and efficiently.
Follow the steps to successfully complete the Teva Cares Form online.
- Press the ‘Get Form’ button to access the Teva Cares Form and open it in your preferred online editor.
- Begin by filling out the patient information section. Provide your name, social security number, date of birth, mailing address, and contact details accurately.
- Next, complete the financial information section. Indicate the number of people in your household and provide your total yearly income as per the income guidelines.
- In the insurance information section, indicate whether you have insurance coverage. For each insurance policy, include the required details such as the name of the insurance provider, phone number, and IDs.
- Review the consent language carefully. By signing it, you agree to share your medical and financial information with the Teva Cares Foundation.
- Save changes to the form. At this point, you may also need to attach copies of proofs of income required for the application.
- Finally, submit the completed form and any required documents. You can either download and print the form to mail it or share it if applicable.
Complete the Teva Cares Form online today to see if you qualify for the Patient Assistance Program.
The TEVA CARES FOUNDATION Patient Assistance Program provides prescription medicines at no cost to patients who qualify. If you have no prescription drug coverage and meet the income guidelines below, you may qualify for this program. Please complete and submit this application to see if you qualify.
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