Enroll Your Patients For Personalized Support
To enroll your patients for personalized support, fill out the “Personalized Patient Support Programs” section of the applicable enrollment form below. Make sure to work with your patients to fill out the required information.
To find out which enrollment form is applicable for your patient, first check here to see if your patient is eligible for the Pfizer Patient Assistance Program.†
If your patient is eligible, download to complete and submit the Patient Assistance Program Enrollment Form below.
PATIENT ASSISTANCE PROGRAMPatients who are not eligible for the Pfizer Patient Assistance Program can be enrolled for reimbursement support services by completing and submitting the form below.
REIMBURSEMENT SUPPORT SERVICES