Reach Patient Assistance

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Download Application

To get started, simply download an application below, complete it and return it to our office by one of the methods below: 

  • Email to info@reachpa.com
  • Fax toll-free to 1-866-727-8633
  • Mail to P.O. Box 181, American Fork, Utah 84003

To download an application form, simply click the download link below. If you still have questions or need assistance, please call us Toll-Free at 1-888-727-8633. We'll be happy to help. 
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Reach Patient Assistance, LLC
Toll-Free Phone: 1-888-727-8633
Toll-Free Fax: 1-866-727-8633

info@reachpa.com

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