patient assistance
Financial assistance — application and submission instructions
Confirm the exact product or service
National contact — confirm product and location
Completed financial-assistance application and required income documentation, as directed on the linked form.
The currently linked application has a 2026 copyright and a June 2026 filename. It publishes two application-question numbers distinct from the dated patient-billing routes. Eligibility must be confirmed by CPL. Although the webpage mentions email, the form does not supply an enrollment email; none is inferred.
View source ↗ · Source checked 2026-10-22 · Current page linking the application ↗
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