Download Application
To get started, simply download an application below, complete it and return it to our office by one of the methods below:
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.
- Email to [email protected]
- 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.
Reach Patient Assistance, LLC
Toll-Free Phone: 1-888-727-8633
Toll-Free Fax: 1-866-727-8633
[email protected]
Toll-Free Phone: 1-888-727-8633
Toll-Free Fax: 1-866-727-8633
[email protected]
