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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 photo

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 have been prescribed VENCLEXTA® (venetoclax tablets), you must fill out the VENCLEXTA Patient Consent Form. Please see VENCLEXTA Forms and Documents to download this form.

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  • Complete and submit a form electronically.