Get Novartis Patient Assistance Foundation Enrollment Application 2017

The Novartis Patient Assistance Foundation Enrollment Application is a critical tool for individuals seeking access to Novartis medications. This guide provides clear and supportive instructions to help users complete the application effectively online.

Follow the steps to successfully complete the enrollment application.

1. Press the ‘Get Form’ button to obtain the enrollment application, then open the document in your preferred editor.
2. Begin with the Patient Section A. Fill in your full name, address, and contact information, ensuring that you use accurate details to avoid delays.
3. Provide financial information by attaching a copy of your household's most recent year's tax returns or recent paycheck stubs/bank statements. Ensure not to send original documents.
4. Indicate your status as a U.S. resident and provide your Social Security number, ensuring it is complete and correct.
5. List the total number of people residing in your home, including yourself, and break down the number of children and adults living there.
6. Detail all sources of gross monthly income, including salary, pension, unemployment benefits, and any other relevant financial contributions that support your household.
7. Complete the Patient Insurance section by including copies of your insurance cards and indicating the types of coverage you have. This section is crucial for eligibility assessment.
8. In the Patient Consent Section, read the consent carefully and provide your signature and date to authorize information sharing necessary for processing your application.
9. After completing Patient Section A, review all entries for accuracy. Ensure that you have attached all required documentation.
10. Proceed to submit the completed form either by mailing it to the specified address or faxing it as directed, ensuring to include all necessary documentation.

Begin your application process now to access your Novartis medications online.