Forms and Documents

Download the form you need to enroll in Genentech Access Solutions and a helpful guide to use when talking to your doctor's office.

 

Start Enrollment With the Patient Consent Form

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

  • Fill out and submit the form online
  • Sign a printed form, take a photo and text it to  (650) 877-1111
  • Sign a printed form and fax or mail it to us (or give it to your doctor's office to do so) 

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.

Coverage Support Discussion Guide

This information packet includes:

  • Information on how to enroll in Genentech patient support services
  • A worksheet to use to help you understand the costs of your treatment