Use this form to text your patient a link requesting their proof of income for a patient assistance program application:

I hereby consent to receive SMS messages for the purpose of receiving updates about my patient assistance application. I understand that these messages may include information about the status of my application, medication refill reminders, and other relevant updates. I acknowledge that standard message and data rates may apply, and I am responsible for any associated costs. I may opt-out of receiving SMS messages at any time by following the provided instructions. By providing my consent, I confirm that I have read and understood the terms and conditions of receiving SMS updates. My consent is voluntary and can be revoked at any time.

Use this form to check the cost of the procedure your patient needs:

I hereby consent to receive SMS messages for the purpose of receiving updates about my patient assistance application. I understand that these messages may include information about the status of my application, medication refill reminders, and other relevant updates. I acknowledge that standard message and data rates may apply, and I am responsible for any associated costs. I may opt-out of receiving SMS messages at any time by following the provided instructions. By providing my consent, I confirm that I have read and understood the terms and conditions of receiving SMS updates. My consent is voluntary and can be revoked at any time.