Get Patient Assistance Consideration Application - Tactile Medical

Filling out the Patient Assistance Consideration Application online is a straightforward process designed to help users access support for their medical needs. This guide provides a step-by-step approach to ensure that all necessary information is accurately submitted.

Follow the steps to successfully complete the application.

1. Click the ‘Get Form’ button to obtain the application and open it in your preferred digital editor.
2. Begin by entering your personal information in the 'Patient Information' section. This includes your name, date of birth, street address, phone number, city/state/zip code, and email address.
3. Proceed to the 'Household Financial Information' section. Here, provide your adjusted gross household income, indicating either your monthly or yearly earnings. Specify the number of individuals who contribute to this income and the number supported by it.
4. In the 'Documentation of Household Income' section, upload copies of the relevant documents as proof of income. You may submit a federal tax form, Medicaid information, paycheck statements, Social Security statements, pension statements, or bank statements, ensuring they reflect your reported income.
5. If applicable, detail any 'Special Circumstances' that may affect your financial situation. Be sure to include dollar amounts for any medical-related expenses that impact your ability to pay for the pneumatic compression device.
6. Finally, review the 'Signature and Approval' section. By signing, you certify that all provided information is accurate and understand that Tactile Medical will use this data to assess your financial need.
7. After completing the application, ensure all necessary documentation is attached. You can then submit your application by email, fax, or mail as specified at the end of the form.

Begin filling out your Patient Assistance Consideration Application online today to ensure you receive the support you need.