Resources & Tools
Document Checklist
Please use the following checklist to make sure you have done everything to complete the application process:
- All fields of the application are completed or N/A is indicated
- Healthcare provider has signed page 3 of application
- Patient has signed page 4 of application
- Product(s) are selected on page 2 of application
- Most recent federal tax return is attached or box indicating patient does not file taxes is checked on application
- Copy of application is retained for your records