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Dedicated to providing only the highest quality health care
Patient Assistance
Patients requesting financial assistance for prescription medications can do so by completing the appropriate form. Please locate the medication from the list below and download the form. Many forms require supplemental financial documents (tax return, Social Security statements). After completing all patient sections of the form, bring the completed application and required documentation to the office. Incomplete applications will not be accepted. Once the provider portions are completed, the application will be submitted to the designated organization.
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