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ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI® (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG® (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA® (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO® (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO® (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO® (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO® (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

ACTEMRA® (tocilizumab)‎ ALECENSA® (alectinib) Avastin® (bevacizumab) COLUMVI® (glofitamab-gxbm) COTELLIC® (cobimetinib) ENSPRYNG® (satralizumab-mwge) Erivedge® (vismodegib) Evrysdi® (risdiplam) GAZYVA® (obinutuzumab) HEMLIBRA® (emicizumab-kxwh) Herceptin® (trastuzumab) Herceptin HYLECTA® (trastuzumab and hyaluronidase-oysk) Itovebi™ (inavolisib) KADCYLA® (ado-trastuzumab emtansine) LUCENTIS® (ranibizumab injection) LUNSUMIO® (mosunetuzumab-axgb) OCREVUS® (ocrelizumab) and OCREVUS ZUNOVO® (ocrelizumab & hyaluronidase-ocsq) PERJETA® (pertuzumab) PHESGO® (pertuzumab, trastuzumab, and hyaluronidase-zzxf) PiaSky™ (crovalimab-akkz) POLIVY® (polatuzumab vedotin-piiq) Pulmozyme® (dornase alfa) Inhalation Solution Rituxan® (rituximab) for Rheumatoid Arthritis (RA) RITUXAN® (rituximab) for Oncology Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA), Microscopic Polyangiitis (MPA) or Pemphigus Vulgaris (PV) RITUXAN HYCELA® (rituximab/hyaluronidase human) ROZLYTREK® (entrectinib) SUSVIMO® (ranibizumab injection) TECENTRIQ® (atezolizumab) TECENTRIQ HYBREZA™ (atezolizumab and hyaluronidase-tqjs) VABYSMO® (faricimab-svoa) VENCLEXTA® (venetoclax tablets) XOLAIR® (omalizumab) for subcutaneous use ZELBORAF® (vemurafenib) Oncology Ophthalmology Rheumatology

Here you can download the form you need to enroll in Genentech Access Solutions.

To get started, fill out the Patient Consent Form. There are 3 ways to send us the Patient Consent Form:

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Complete it online

Complete it online by selecting the eSubmit icon below

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Text a picture of the completed form to (650) 877-1111

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Send it via fax

Fill out a paper copy and fax it or mail it to us (or give it to your doctor to do so)

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Your doctor also has to fill out 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.

If you or your child has been prescribed Evrysdi® (risdiplam), you must fill out the patient consent section of the Evrysdi Start Form. Please see Evrysdi Forms and Documents to find this form.

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  • patient consent form

    Patient Consent Form

    The Patient Consent Form gives us permission to discuss your health information with others, such as your doctor and your health insurance plan, so we can perform our services.
  • patient consent form

    Formulario de Consentimiento del Paciente

    El Formulario de Consentimiento del Paciente nos da permiso para analizar su información de salud con otras personas, como su médico y su plan de seguro médico, para que podamos prestar nuestros servicios.
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  • Complete and submit a form electronically.