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Health Care Providers
If you are a health care provider, click below to learn how to apply online or via fax.
Apply NowPatients
If you are a patient, click below to learn how to begin your application process.
Apply NowContact Us
If you have questions about the application process, a foundation specialist is ready to help.
Call: (888) 941-3331
M-F, 6 a.m.–5 p.m.
How to Enroll in Genentech Patient Support Services and the Genentech Patient Foundation
This video walks you through the steps needed to enroll in the Genentech Patient Foundation and other Genentech patient support services.
Please Note: At this time, Genentech supports Nutropin, Cellcept, Valcyte, and Fuzeon through a separate process.
Learn more about these support programs
Health Care Providers
Health Care Providers can submit the completed Patient Consent and Prescriber Foundation form in two ways:
Option 1: Submit forms online
If your practice has a registered account for My Patient Solutions, you can get started by logging into your account.
Log into My Patient Solutions.
Don't have an account?
Step 1: Ask your patient to complete the online Patient Consent Form, which is available in English and Spanish:
Patient Consent Form | Formulario de Consentimiento del Paciente
Step 2: Complete the online Prescriber Foundation Form.
Option 2: Print forms and fax or text
Step 1: Print the Patient Consent Form for your patient to complete, which is available in English and Spanish:
Patient Consent Form | Formulario de Consentimiento del Paciente
Step 2: Print and complete the Prescriber Foundation Form.
Step 3: Submit the completed forms via fax or text.
Send via fax to 833-999-4363
Text a photo of the form to 650-877-1111
Both forms are required. No action can be taken until a completed Patient Consent Form and Prescriber Foundation Form have been received.
The request will be processed within 5 business days upon receipt of both required forms and your office will be contacted to discuss the application outcome and any next steps
Patients
Step 1: Complete the online Patient Consent Form, which is available in English and Spanish:
Patient Consent Form | Formulario de Consentimiento del Paciente
Step 2: Once you have completed the Patient Consent form, you can inform your doctor's office and let them know that you are applying for assistance from the Genentech Patient Foundation.
Your doctor will have to complete another form called the Prescriber Foundation Form. Both forms are required. No action can be taken until a completed Patient Consent Form and Prescriber Form have been received.