Apply For Help

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

See if you qualify.

What to Expect

Complete the Form

The Genentech Patient Foundation Enrollment Form includes important information for patients and health care providers. Both the patient and the health care provider need to review and sign the enrollment form. The form includes specific instructions on how to apply and where to fax the completed enrollment form.

Send the Form

Fax the Enrollment Form to (833) 999-4363.

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.