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Download the form you need to enroll in Genentech Access Solutions.

Start Enrollment With the Patient Consent Form

To get started, fill out the Patient Consent Form. You can submit this form in 1 of 3 ways:

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Submit it online

Fill out and submit the form online using eSubmit


Text a photo

Sign a printed form, take a photo and text it to (650) 877-1111

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Send it via fax

Sign a printed form and fax or mail it to us (or give it to your doctor's office to do so)

health care provider

Your doctor also has to fill out a form called the Prescriber Service Form. Once we have both these forms, we can begin working with you and your doctor's office. You do not need to fill out anything on the Prescriber Service Form.

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  • Complete and submit a form electronically.