Apply For Help

If you qualify, one simple form is all you need to apply to the Genentech Patient Foundation.

Please Note: At this time, Genentech supports Nutropin, Cellcept, Valcyte, and Fuzeon through a separate process.

Learn more about these support programs here.

What to Expect

Complete the Forms

The Genentech Patient Foundation requires the completion of two forms to enroll into the Genentech Patient Foundation.

  1. Prescriber Foundation Form (to be completed by health care provider)
  2. Patient Consent Form (to be completed by Patient)

The Prescriber Foundation Form includes specific instructions on how to apply & where to fax the completed enrollment forms. Please visit the See if You Qualify page for more information on eligiblity prior to completing the forms.

Send the Form

Fax the enrollment forms to (833) 999-4363.

Note: The Patient Consent Form can be submitted in a variety of ways. For more information please visit https://www.genentech-access.com/patientconsent

We’ll Contact You

You can expect to hear from a Foundation Specialist to let you know if the application was approved or if we need more information.

Get Your Medicine

Once the application is approved, we’ll send the Genentech medicine to the patient or the health care provider’s office as directed on the form as quickly as possible.